Defined as the implantation and development of the egg outside the uterine cavity, ectopic pregnancy is the leading cause of maternal mortality in the first trimester of pregnancy. In Senegal, their frequency varies around 0.6% according to certain hospital data. The tubal location is the most common but other rare and even exceptional locations have been described, often leading to diagnostic error which can lead to heavy female morbidity and mortality. We report two cases through which we will describe the diagnostic, therapeutic and prognostic modalities. It was an observational study of two atypical cases of ectopic pregnancy diagnosed and treated in the gynecology-obstetrics department of the Pikine National Hospital Center. In both cases, a definitive diagnosis was only established after laparotomy. The main challenge lay in performing the surgical procedure in a manner that would preserve future fertility.
References
[1]
Ferrand, S., Madelenat, P., Menard, A., Crequat, J., Hauuy, J.P. and Cassuto, G. (1990) Vers un traitement ambulatoire de la grossesse extra-utérine. Contraception, Fertilité, Sexualité, 18, 181-184.
[2]
Dimitry, E.S., Subak-Sharpe, R., Mills, M., Margara, R. and Winston, R. (1990) Nine Cases of Heterotopic Pregnancies in 4 Years of in Vitro Fertilization. Fertility and Sterility, 53, 107-110. https://doi.org/10.1016/s0015-0282(16)53225-7
[3]
Diallo, D., Aubard, Y., Piver, P. and Baudet, J.H. (2000) Grossesse hétérotopique: À propos de 5 cas et revue de la littérature. Journal of Gynecology, Obstetrics, Biology of Reproduction, 29, 131-141.
[4]
Laghzaoui Boukaïdi, M., Bouhya, S., Sefrioui, O., Bennani, O., Hermas, S. and Aderdour, M. (2002) Grossesses hétérotopiques: À propos de huit cas. Gynécologie, Obstétrique et Fertilité, 30, 218-223.
[5]
Jibodu, O.A. and Darne, F.J. (1997) Spontaneous Heterotopic Pregnancy Presenting with Tubal Rupture. Human Reproduction, 12, 1098-1099. https://doi.org/10.1093/humrep/12.5.1098
[6]
Inion, I., Gerris, J., Joostens, M., De Vree, B., Kockx, M. and Verdonk, P. (1998) An Unexpected Triplet Heterotopic Pregnancy after Replacement of Two Embryos. Human Reproduction, 13, 1999-2001. https://doi.org/10.1093/humrep/13.7.1999
[7]
Parant, O., Mehu, F., El Ghaoui, A., Parinaud, J. and Monrozies, X. (1998) Grossesse hétérotopique et FIV. Revue de la littérature à propos d’un cas de grossesse hétérotopique intersti-tielle traitée avec succès de manière conservatrice. Revue Française de Gynécologie et d’Obstétrique, 93, 130-134.
[8]
Tal, J., Haddad, S., Gordon, N. and Timor-Tritsch, I. (1996) Heterotopic Pregnancy after Ovulation Induction and Assisted Reproductive Technologies: A Literature Review from 1971 to 1993. Fertility and Sterility, 6, 1-12.
[9]
Strohmer, H., Obruca, A., Lehner, R., Egarter, C., Husslein, P. and Feichtinger, W. (1998) Successful Treatment of a Heterotopic Pregnancy by Sonographically Guided Instillation of Hyperosmolar Glucose. Fertility and Sterility, 69, 149-151. https://doi.org/10.1016/s0015-0282(97)00448-2
[10]
Rizk, B., Tan, S.L., Morcos, S., Riddle, A., Brinsden, P., Mason, B.A., et al. (1991) Heterotopic Pregnancies after in Vitro Fertilization and Embryo Transfer. American Journal of Obstetrics and Gynecology, 164, 161-164. https://doi.org/10.1016/0002-9378(91)90648-b
[11]
Habana, A., Dokras, A., Giraldo, J.L. and Jones, E.E. (2000) Cornual Heterotopic Pregnancy: Contemporary Management Options. American Journal of Obstetrics and Gynecology, 182, 1264-1270. https://doi.org/10.1067/mob.2000.103620
[12]
Fait, G., Goyert, G., Sundareson, A. and Pickens, A. (1987) Intramural Pregnancy with Fetal Survival: Case History and Discussion of Etiologic Factors. Obstetrics and Gynecology, 70, 472-474.
[13]
Guena, M.N., Nana, A.N. and Amvene, S.N. (2017) Grossesse cornuale droite de découverte tardive et Fortuite à l’échographie de Routine. Health Sciences and Disease, 18, 1-5.
[14]
Fernandez, H., Lelaidier, C., Doumerc, S., Fournet, P., Olivennes, F. and Frydman, R. (1993) Nonsurgical Treatment of Heterotopic Pregnancy: A Report of Six Cases. Fertility and Sterility, 60, 428-432. https://doi.org/10.1016/s0015-0282(16)56155-x
[15]
Sentilhes, L., Bouet, P., Gromez, A., Poilblanc, M., Lefebvre-Lacoeuille, C. and Descamps, P. (2009) Successful Expectant Management for a Cornual Heterotopic Pregnancy. Fertility and Sterility, 91, 934.e11-934.e13. https://doi.org/10.1016/j.fertnstert.2008.09.072
[16]
Korkontzelos, I., Antoniou, N., Stefos, T., Kyparos, I. and Lykoudis, S. (2005) Ruptured Heterotopic Pregnancy with Successful Obstetrical Outcome: A Case Report and Review of the Literature. Clinical and Experimental Obstetrics & Gynecology, 32, 203-206.
[17]
Bouyer, J. (2003) Épidémiologie de la grossesse extra-utérine, incidence, facteur de risque et conséquence. Journal de GynécologieObstétrique et Biologiede la Reproduction, 24, 8-17.
[18]
Bornstein, E., Berg, R., Santos, R., Monteagudo, A. and Timor-Tritsch, I.E. (2011) Term Singleton Pregnancy after Conservative Management of a Complicated Triplet Gestation Including a Heterotopic Cornual Monochorionic Twin Pair. Journal of Ultrasound in Medicine, 30, 865-867. https://doi.org/10.7863/jum.2011.30.6.865
[19]
Ong, C., Su, L., Chia, D., Choolani, M. and Biswas, A. (2010) Sonographic Diagnosis and Successful Medical Management of an Intramural Ectopic Pregnancy. Journal of Clinical Ultrasound, 38, 320-324. https://doi.org/10.1002/jcu.20703
[20]
Nabeshima, H., Nishimoto, M., Utsunomiya, H., Arai, M., Ugajin, T., Terada, Y., et al. (2010) Total Laparoscopic Conservative Surgery for an Intramural Ectopic Pregnancy. Diagnostic and Therapeutic Endoscopy, 2010, Article ID: 504062. https://doi.org/10.1155/2010/504062
[21]
Canis, M., Savary, D., Pouly, J.L., Wattiez, A. and Mage, G. (2003) Grossesse extra-utérine: Critères de choix du traitement médical ou du traitement chirurgical. Journal of Gynecology, Obstetrics, Biology of Reproduction, 32, 354‐363.
[22]
Lau, S. and Tulandi, T. (1999) Conservative Medical and Surgical Management of Interstitial Ectopic Pregnancy. Fertility and Sterility, 72, 207-215. https://doi.org/10.1016/s0015-0282(99)00242-3
[23]
Cisse, C.A.T., De Bernis, L., Faye, E.O. and Diadiou, F. (2002) Grossesse extra-utérine au Sénégal. Carnets de Santé, 12, 271-274
[24]
Lee, G.S.R., Hur, S.Y., Kown, I., Shin, J.C., Kim, S.P. and Kim, S.J. (2005) Diagnosis of Early Intramural Ectopic Pregnancy. Journal of Clinical Ultrasound, 33, 190-192. https://doi.org/10.1002/jcu.20107
[25]
Ko, H., Lee, Y., Lee, H., Park, I., Chung, D., Kim, S., et al. (2006) Sonographic and MR Findings in 2 Cases of Intramural Pregnancy Treated Conservatively. Journal of Clinical Ultrasound, 34, 356-360. https://doi.org/10.1002/jcu.20245
[26]
Bouzari, Z., Keshani, M., Yazdani, S., Barat, S. and Zinalzadeh, M. (2010) Intramural pregnancy. Journal of Obstetrics and Gynaecology, 30, 195-196. https://doi.org/10.3109/01443610903443921
[27]
Lyu, J., Sun, W. and Lin, Y. (2018) Successful Management of Heterotopic Intramural Pregnancy Leading to a Live Birth of the Intrauterine Pregnancy. Journal of Minimally Invasive Gynecology, 25, 1126-1127. https://doi.org/10.1016/j.jmig.2018.01.003
[28]
Zhang, Y., Chen, X., Lin, Y., Lian, C. and Xiong, X. (2022) Study on Diagnosis and Management Strategies on Heterotopic Pregnancy: A Retrospective Study. Journal of Obstetrics and Gynaecology, 43, e2152660. https://doi.org/10.1080/01443615.2022.2152660
[29]
Meng, S.M. and Meng, S.Q. (2004) Rupture of Uterus in Intramural Pregnancy—A Case Report. Chinese Journal of Obstetrics and Gynecology, 39, Article 429.
[30]
Xiang, J., Chen, F., Cai, Z. and Bao, R. (2024) A Rare Case of Fundal Intramural Ectopic Pregnancy Associated with Previous B-Lynch Sutures. BMC Women’s Health, 24, Article No. 3027. https://doi.org/10.1186/s12905-024-03027-w
[31]
Çalifikan, E., Cakirogl, Y. and Çorakçi, A. (2020) Expectant Management of an Intramural Ectopic Pregnancy in a Primigravid Woman. Journal of Turkish-German Gynecological Association, 21,302-305.
