Skip to main content
Log in

Heterotopic triplets: tubal ectopic and twin intrauterine pregnancy. A review of obstetric outcomes with a case report

  • Materno-fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Introduction

Heterotopic triplets hardly take place, but nowadays the extended use of assisted reproductive technologies is increasing the ectopic pregnancies rate and subsequently the heterotopic pregnancies, leading to a potentially dangerous condition for the woman and the intrauterine pregnancy.

Material and methods

Fourteen cases previously reported in the literature of patients presenting an intrauterine twin pregnancy which became complicated by a tubal ectopic pregnancy have been reviewed. The case of a patient following a homologous intrauterine insemination treatment, resulting in live birth of both twins, is also described.

Conclusion

Although the diagnosis of heterotopic triplets with tubal ectopic is challenging, a timely surgical treatment will preserve intrauterine gestation with a great chance of a successful obstetric outcome for both twins.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Richards SR, Stempel LE, Carlton BD (1982) Heterotopic pregnancy: Reappraisal of incidence. Am J Obstet Gynecol 142(7):928–930

    CAS  PubMed  Google Scholar 

  2. Yovich JL, McColm SC, Turner SR, Matson PL (1985) Heterotopic pregnancy from in vitro fertilization. J In Vitro Fert Embryo Transf 2(3):143–150

    Article  CAS  PubMed  Google Scholar 

  3. Goldman GA, Fisch B, Ovadia J, Tadir Y (1992) Heterotopic pregnancy after assisted reproductive technologies. Obstet Gynecol Surv 47(4):217–221

    Article  CAS  PubMed  Google Scholar 

  4. Payne S, Duge J, Bradbury W (1971) Ectopic pregnancy concomitant with twin intrauterine pregnancy. A case report. Obstet Gynecol 38(6):905–906

    CAS  PubMed  Google Scholar 

  5. Walker TA, Baden WF (1972) Tubal pregnancy complicating uterine twin pregnancy after ovulation-induction therapy. Surg Clin North Am 52(2):425–428

    CAS  PubMed  Google Scholar 

  6. Sondheimer SJ, Tureck RW, Blasco L, Strauss J IIIrd, Arger P, Mennuti M (1985) Simultaneous ectopic pregnancy with intrauterine twin gestations after in vitro fertilization and embryo transfer. Fertil Steril 43(2):313–316

    CAS  PubMed  Google Scholar 

  7. Berliner I, Mesbah M, Zalud I, Maulik D (1998) Heterotopic triplet pregnancy. Report of a case with successful twin intrauterine gestation. J Reprod Med 43(3):237–239

    CAS  PubMed  Google Scholar 

  8. Inion I, Gerris J, Joostens M, De Vree B, Kockx M, Verdonk P (1998) An unexpected triplet heterotopic pregnancy after replacement of two embryos. Hum Reprod 13(7):1999–2001

    Article  CAS  PubMed  Google Scholar 

  9. Barnett A, Chipchase J, Hewitt J (1999) Simultaneous rupturing heterotopic pregnancy and acute appendicitis in an in vitro fertilization twin pregnancy. Hum Reprod 14(3):850–851

    Article  CAS  PubMed  Google Scholar 

  10. Nair P, Chauhan M (1999) Heterotopic pregnancy (triplets) following in vitro fertilisation: case report. Arch Gynecol Obstet 263(1–2):84–85

    Article  CAS  PubMed  Google Scholar 

  11. Nguyen-Tran C, Toy EC (2000) Case 3: obstetrical. Heterotopic pregnancy: viable twin intrauterine pregnancy with a viable right tubal ectopic pregnancy. J Ultrasound Med 19(5):355

    CAS  PubMed  Google Scholar 

  12. Oliveira FG, Abdelmassih V, Abdelmassih Oliveira S, Abdelmassih R, Nagy ZP (2002) Heterotopic triplet pregnancy: report and video of a case of a ruptured tubal implantation with living embryo concurrent with an intrauterine twin gestation. Reprod Biomed Online 5(3):313–316

    Article  PubMed  Google Scholar 

  13. Cenk Sayin N, Yardim T (2003) Live birth of healthy twins after a heterotopic tubal and intrauterine twin pregnancy in a woman who was stimulated with clomiphene citrate. Fertil Steril 80(5):1265–1267

    Article  CAS  PubMed  Google Scholar 

  14. Strelec M, Dmitrovic R, Simunic V (2004) Heterotopic triplet pregnancy with laparoscopic resection of the ruptured tube at 10 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 117(1):117–118

    Article  PubMed  Google Scholar 

  15. Childs AJ, Royek AB, Leigh TB, Gallup PG (2005) Triplet heterotopic pregnancy after gonadotropin stimulation and intrauterine insemination diagnosed at laparoscopy: a case report. South Med J 98(8):833–835

    Article  PubMed  Google Scholar 

  16. Muller Vranjes A, Popović Z, Vlahović I, Habek D, Kasac Z (2006) Heterotopic trigeminal pregnancy in infertile women after ovulation stimulation and embolisation of a uterine myoma. Fetal Diagn Ther 21(1):81–83

    Article  CAS  PubMed  Google Scholar 

  17. Cholkeri-Singh A, LaBarge A (2007) Spontaneous heterotopic triplets: a case report. Fertil Steril 88(4):968 e5–7

    PubMed  Google Scholar 

  18. De Sutter P (2006) Rational diagnosis and treatment in infertility. Best Pract Res Clin Obstet Gynaecol 20(5):647–664

    Article  PubMed  Google Scholar 

  19. Fu J, Henne MB, Blumstein S, Lathi RB (2007) Rupture of ectopic pregnancy with minimally detectable beta-human chorionic gonadotropin levels: a report of 2 cases. J Reprod Med 52(6):541–542

    PubMed  Google Scholar 

  20. Fernandez H, Lelaidier C, Doumerc S, Fournet P, Olivennes F, Frydman R (1993) Nonsurgical treatment of heterotopic pregnancy: a report of six cases. Fertil Steril 60(3):428–432

    CAS  PubMed  Google Scholar 

  21. Ocal P, Erkan S, Cepni I, Idil MH (2007) Transvaginal ultrasound-guided aspiration and instillation of hyperosmolar glucose for treatment of unruptured tubal heterotopic pregnancy. Arch Gynecol Obstet 276(3):281–283

    Article  PubMed  Google Scholar 

  22. Goldstein JS, Ratts VS, Philpott T, Dahan MH (2006) Risk of surgery after use of potassium chloride for treatment of tubal heterotopic pregnancy. Obstet Gynecol 107(2 Pt 2):506–508

    PubMed  Google Scholar 

  23. Fernandez H, Gervaise A (2004) Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy. Hum Reprod Update 10(6):503–513

    Article  PubMed  Google Scholar 

  24. Tal J, Haddad S, Gordon N, Timor-Tritsch I (1996) Heterotopic pregnancy after ovulation induction, assisted reproductive technologies: a literature review from 1971 to 1993. Fertil Steril 66(1):1–12

    CAS  PubMed  Google Scholar 

  25. Reedy MB, Källén B, Kuehl TJ (1997) Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 177(3):673–679

    Article  CAS  PubMed  Google Scholar 

  26. Al-Fozan H, Tulandi T (2002) Safety and risks of laparoscopy in pregnancy. Curr Opin Obstet Gynecol 14(4):375–379

    Article  PubMed  Google Scholar 

  27. Jackson H, Granger S, Price R et al (2008) Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surg Endosc 22(9):1917–1927

    Article  PubMed  Google Scholar 

  28. Louis-Sylvestre C, Morice P, Chapron C, Dubuisson JB (1997) The role of laparoscopy in the diagnosis and management of heterotopic pregnancies. Hum Reprod 12(5):1100–1102

    Article  CAS  PubMed  Google Scholar 

  29. Glassner MJ, Aron E, Eskin BA (1990) Ovulation induction with clomiphene and the rise in heterotopic pregnancies. A report of two cases. J Reprod Med 35(2):175–178

    CAS  PubMed  Google Scholar 

  30. Leiserowitz GS (2006) Managing ovarian masses during pregnancy. Obstet Gynecol Surv 61(7):463–470

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Fernando Bugatto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bugatto, F., Quintero-Prado, R., Kirk-Grohar, J. et al. Heterotopic triplets: tubal ectopic and twin intrauterine pregnancy. A review of obstetric outcomes with a case report. Arch Gynecol Obstet 282, 601–606 (2010). https://doi.org/10.1007/s00404-010-1577-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-010-1577-z

Keywords

Navigation