Laparoscopic management of quadruplet heterotopic pregnancy after ovarian stimulation cycle

Abstract

Introduction. We report a rare case of a heterotopic abdominal pregnancy with three intrauterine pregnancy, one with a viable fetus, treated successfully by laparoscopy. Methods. A 40-year-old patient with primary sterility, who un- derwent pharmacological ovulation induction, presented abdominal pain in the right iliac region. A trans-vaginal ultrasound showed an image suggestive of ectopic gestation near the right ovary, associated with three intrauterine gestational sacs with only one viable fetus. Basing on this observation, we performed an operative laparoscopy that confirmed the presence of a right ectopic abdominal pregnancy. Since the right ampullar tubal was ruptured and bleeding, we car- ried out a salpingectomy with complete removal of ectopic abdominal pregnancy. Discussion. After laparoscopic surgery, on postoperative day 1, ultrasonographic examination showed an ongoing intrauterine pre- gnancy with the two empty gestational sacs. Postoperative course was without any complications and the patient was discharged on posto- perative day 3. Gestation went on uneventfully until at term vaginal delivery.Conclusions: Laparoscopic treatment of abdominal pregnancy with an intrauterine viable pregnancy resulted safe for both mother and fetus. An adnexal mass in a pregnant patient with a history of ovulation induction might be the indicator of an heterotopic pre- gnancy.