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Purpose The aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality. Methods This was a retrospective analysis of pregnancy-related records from a tertiary center over a period of ten years. Data on age, gravidity, parity, EP risk, amenorrhea duration, abdominal pain presence and location, β-human chorionic gonadotropin (β-HCG) level, ultrasound findings, therapeutic intervention, exact EP implantation site and length of hospital stay (LOS) were obtained from the database. The LOS was used as a proxy for morbidity and was tested for an association with all variables. All statistical analyses were conducted with Stata® (ver. 16.1, Texas, USA). Results The incidence of EP in a cohort of 30,247 pregnancies over a ten-year period was 1.05%. Patients presented with lower abdominal pain in 87.9% of cases, and the likelihood of experiencing pain was tenfold higher if fluid was detectable in the pouch of Douglas. Only 5.1% of patients had a detectable embryonic heartbeat, and 18.15% had one or more risk factors for EP. While most EPs were tubal, 2% were ovarian. The LOS was 1.9 days, and laparoscopic intervention was the main management procedure. The cohort included one genetically proven dizygotic heterotopic pregnancy (incidence, 3.3 × 10 − 5 ) that was diagnosed in the 7th gestational week. The only association found was between the β-HCG level and LOS, with a linear regression β coefficient of 0.01 and a P -value of 0.04. Conclusion EP is a relatively common condition affecting approximately 1% of all pregnancies. β-HCG correlates with EP-related morbidity, but the overall morbidity rate of EP is low regardless of the implantation site. Laparoscopic surgery is an effective therapeutic procedure that is safe for managing EP, even in cases of heterotopic pregnancy.

Background and objective: Spontaneous heterotopic pregnancy (SHP) is a rare condition represented by the synchronous coexistence of an intrauterine and an ectopic pregnancy. It rarely occurs with natural conception and is usually a consequence of assisted reproductive techniques. Diagnosis of SHP can be a challenge for the clinician. The evolution of the intrauterine pregnancy is dependent on many factors, such as the location of the heterotopic pregnancy, gestational age at the time of diagnosis, the surgical procedure, the presence of other risk factors, early or delayed management. The aim of this systematic review of the literature was to extract existing evidence on spontaneous heterotopic pregnancy with otherwise unaffected intrauterine pregnancy. Materials and Methods: From a total of 1907 database entries identified in PubMed, EMBASE and Cochrane reviews, we selected 18 papers for narrative synthesis, for which we explored the diagnostic options, treatment, and outcome of these extremely rare epidemiologic occurrences. Manuscripts were assessed using the CARE guidelines for reporting case reports. Results: The main symptom was abdominal pain, and the preferred treatment approach was surgical, more precisely, using a laparoscopic approach. Most cases presented no risk factors, and the diagnosis was mostly made in the first semester. Conclusions: Normal follow-up and evolution of intrauterine pregnancy have been observed regardless of surgical approach (open or laparoscopic). Early diagnosis and treatment are advised, as they impact maternal and fetal outcomes. Evidence on this topic is scarce, predominantly comprised of case reports with variable degrees of adherence to dissemination guidelines. More studies on this topic are required to optimize care protocols for this type of pregnancy.

PurposeThe purpose of this study was to determine the heterotopic pregnancy rate using fresh versus frozen-thawed embryo transfers and factors associated with heterotopic pregnancy (HP). Management and clinical outcomes after heterotopic pregnancy were also evaluated.MethodsIn this retrospective cohort study, we included 12,484 women who had clinical pregnancies after in vitro fertilization treatment at our fertility center between 2012 and 2017. Patients received fresh day 3 embryos (F-D3 group), fresh day 5 blastocysts (F-D5 group), frozen-thawed day 3 embryos (T-D3 group), or frozen-thawed day 5 or 6 blastocysts (T-D5/6 groups) transfers. The primary outcome measure was the occurrence of heterotopic pregnancy. Factors associated with heterotopic pregnancy were analyzed using logistic regression.ResultsThe heterotopic pregnancy rates were 0.58% in the F-D3, 0.39% in F-D5, 0.56% in T-D3, and 0.33% in T-D5/6 groups, but no differences were found between groups. The risk factors of HP included a history of previous ectopic pregnancy (odds ratio [OR] 5.805, 95% CI 4.578–9.553, P = 0.016) and pelvic inflammation diseases (OR 1.129, 95% CI 1.021–3.178, P = 0.047). Salpingectomy was performed in 62.9% patients either through laparoscopy or through laparotomy. The early abortion rate and late abortion rate were 29.03% and 1.61%, respectively. In total, 66.13% of the patients had a live birth, either a singleton (90.24%) or twins (9.76%).ConclusionNo significant difference in the incidence of heterotopic pregnancy in fresh IVF cycles vs. frozen-thawed cycles could be demonstrated in a large cohort of patients. The risk factors of HP included history of ectopic pregnancy and PID. The clinical outcome after heterotopic pregnancy appears to be favorable.

Purpose This study aimed to identify the risk factors and potential prognostic indicators associated with intrauterine pregnancy outcomes following laparoscopic management of heterotopic pregnancies (HPs). Methods A retrospective analysis was conducted on 87 patients who underwent assisted reproductive technology (ART) and laparoscopy at our hospital from January 2010 to May 2023. Based on postoperative intrauterine pregnancy outcomes, the patients were classified into a miscarriage group ( n  = 15) and a delivery group ( n  = 72). Demographic, embryonic, surgical, and pregnancy outcome data were analyzed using statistical methods and and receiver operating characteristic (ROC) curve analysis to determine optimal cutoff values for prognostic indicators. Results In the cohort, 82.76% of postoperative intrauterine pregnancies resulted in live births. Compared with the delivery group, the miscarriage group had a significantly lower number of high-quality transferred embryos (median: 1 vs. 2, P  < 0.001) and a lower rate of intrauterine fetal heartbeat detection on the day of surgery (26.67% vs. 79.17%, P  < 0.001). Serum estradiol (E 2 ) and β-human chorionic gonadotropin (β-HCG) levels in the miscarriage group were significantly reduced both at 14 days after embryo transfer (ET) (667.00 pmol/L vs. 1554.00 pmol/L and 305.01 mIU/mL vs. 541.86 mIU/mL, respectively; both P  < 0.05) and at 3 days after surgery (1698.00 pmol/L vs. 5104.50 pmol/L and 32290.00 mIU/mL vs. 103821.50 mIU/mL, respectively; both P  < 0.05). ROC analysis identified optimal cutoff values for predicting successful intrauterine pregnancy as follows: E 2 ≥704.50 pmol/L and β-HCG ≥ 332.54 mIU/mL at 14 days after ET, and E 2 ≥2315.00 pmol/L and β-HCG ≥ 42502.00 mIU/mL at 3 days after surgery. Conclusions Most HP patients achieve favorable intrauterine pregnancy outcomes after laparoscopy. The transfer of high-quality embryos and systematic monitoring of serum β-HCG and E 2 levels are closely associated with successful postoperative intrauterine pregnancy.These findings highlight the importance of targeted preoperative assessments and vigilant postoperative monitoring in this high-risk patient population, suggesting a pathway for improved clinical protocols and therapeutic interventions.

Purpose The aim of the study is to review the clinical characteristics and risk factors that influence the timing of diagnosis and rupture of interstitial pregnancy, and to evaluate the outcomes of interstitial heterotopic pregnancies after ipsilateral tubal surgery. Methods A retrospective statistical analysis was performed on the case data of patients with interstitial pregnancy who met the inclusion criteria and were treated in a single institution. Results A total of 885 patients with interstitial pregnancy were included in the study, including 55 patients with heterotopic interstitial pregnancies. The gestational age of patients with interstitial rupture was less than those that were diagnosed prior to rupture ( P  < 0.01). The risk of interstitial pregnancy rupture was higher in women with a history of ipsilateral fallopian tube surgery P  < 0.01). In the > 42-day rupture group, the gestation age was less in those with a history of ipsilateral surgery than those without, and the difference was statistically significant ( P  = 0.005). The shorter the interval, the higher the risk of interstitial pregnancy rupture ( P  = 0.001). Conclusion Patients with a history of ipsilateral tubal surgery have a higher risk of interstitial pregnancy rupture. The shorter the interval between ipsilateral tubal surgery and interstitial pregnancy, the higher the risk of rupture. For patients with a combined intrauterine and interstitial pregnancy, timely treatment may improve the chances of achieving term live birth.

ObjectiveThe aims of this study were to summarize the clinical features of patients with heterotopic pregnancy (HP) following embryo transfer (ET) and explore the risk factors for miscarriage after surgery.MethodsAll patients with HP following ET treated by surgery between August 2014 and August 2015 in Chongqing Health Center for Women and Children were retrospectively reviewed.ResultsFifty-five patients were identified, including 40 with tubal HP, 9 interstitial HP and 6 cornual HP. The most frequent manifestations before diagnosis was abdominal pain (29.1%), while 19 patients (34.5%) had no symptoms before diagnosis. The sensitivity of symptoms for HP was 65.5%. Gestational age at symptom onset of these patients with symptoms (n = 36) was 5.8 weeks (range 4.7–8.1). Forty-seven patients (85.5%) were suspected of HP when they received first transvaginal ultrasonography (TVS). The mean gestational age at diagnosis was 6.3 weeks (range 4.7–8.3, 16–41 days after ET). First TVS suggesting HP (P = 0.000) and first TVS performed before day 27 (P = 0.000) were two independent predictors for gestational age at diagnosis. Gestational age at surgery day was 6.7 weeks (range 5.3–10.7). Fifty-one patients (92.7%) resulted in a live birth. Gestational age at surgery day was the only independent risk factor for miscarriage in patients with HP treated by laparotomy (OR 0.003, 95% CI 0.001–0.604).ConclusionsRoutine TVS at day 27 after ET could facilitate the diagnosis of HP, symptoms onset before or after day 27 are clues to early diagnosis. Prompt surgery after diagnosis may improve the prognosis of HP following ET.

Background Heterotopic pregnancy is a rare but potentially life-threatening condition for which both laparoscopy and laparotomy are treatment options. This meta-analysis aimed to compare the efficacy and safety of laparoscopy and laparotomy in the treatment of heterotopic pregnancies. Methods PubMed, Web of Science, ScienceDirect, Wanfang, CNKI, and VIP databases were searched for articles published up to January 2025. Studies were included if they involved women with heterotopic pregnancies, used laparoscopy as the intervention and laparotomy as the comparator, and reported pregnancy-related outcomes. Effect estimates were presented as odds ratios (ORs) with 95% confidence intervals (CIs) and pooled analyses were performed using a random-effects model. Results Twenty-two studies involving 1,133 patients with heterotopic pregnancies were included in the final meta-analysis. No significant differences were found between laparoscopy and laparotomy regarding live birth rate (OR: 0.93; 95% CI: 0.59–1.46; P  = 0.743), abortion rate (OR: 1.28; 95% CI: 0.84–1.97; P  = 0.254), preterm birth rate (OR: 1.00; 95% CI: 0.66–1.53; P  = 0.988), full-term birth rate (OR: 0.91; 95% CI: 0.65–1.27; P  = 0.575), cesarean section (OR: 0.82; 95% CI: 0.41–1.61; P  = 0.560), and vaginal delivery (OR: 1.12; 95% CI: 0.49–2.55; P  = 0.788). Subgroup analysis indicated that laparoscopy may be associated with an increased abortion rate when only high-quality studies were pooled (OR: 1.98; 95% CI: 0.81–4.84; P  = 0.135). Conclusion This study found that intrauterine pregnancy outcomes in patients with heterotopic pregnancies in the studied population (all Chinese) were comparable between laparoscopy and laparotomy. However, the generalizability of these findings to other populations requires further investigation. Study registration INPLASY202530131

Key Clinical Message Swift and precise identification of heterotopic cesarean scar pregnancy, coupled with standardized treatment approaches for handling possible serious complications, form an essential component in reaching favorable outcomes for patients experiencing this rare type of pregnancy. Heterotopic pregnancy (HP) denotes a form of multiple gestation where intrauterine and ectopic pregnancies coexist. Cesarean scar ectopic pregnancy, on the other hand, involves the implantation of a fetus over the previous cesarean scar. This condition poses a significant risk of uterine rupture, which may lead to serious health complications, and even death. We report a case of a fit 37‐year‐old woman with two previous cesarean deliveries who was diagnosed with a heterotopic cesarean scar pregnancy at 8 weeks gestation following symptoms of lower abdominal pain and delayed menstruation. Both pregnancies demonstrated cardiac activity and the portion of the myometrium located between the bladder wall and the gestational sac was noted to exhibit considerable thinness. The patient underwent an exploratory laparotomy coupled with dilation and curettage and recovered uneventfully. The proper management of a HCSP requires timely diagnosis through ultrasonography. Early diagnosis allows for immediate intervention to prevent complications such as uterine rupture or potentially lethal bleeding.

Objective To evaluate the incidence, predisposing factors, early diagnosis and treatment options of heterotopic pregnancy (HP) following in vitro fertilization and embryo transfer (IVF-ET) procedure. Methods A retrospective review study was performed to identify the HP cases after IVF-ET at the Reproductive Centre in Guangdong Women and Children’s Hospital in China between the years of 2002–2007. Results Twelve out of 1,476 pregnancies (0.81%) were diagnosed for HP, of which nine patients elected for exploratory salpingectomy, two patients received selective fetal reduction by embryo aspiration under ultrasound guidance, and one patient opted for expectant treatment. Postoperatively, four intrauterine pregnancies were continued to develop until term while two were delivered at 35 weeks of gestation. The achievement ratio of continuous pregnancy was 66.7% (6/9). Conclusion The incidence of HP is increasing due to the widespread use of assisted reproductive technology. An early transvaginal sonography performed by experienced radiologist/radiographer is considered to be essential and beneficial in establishing early diagnosis of HP. Both salpingectomy and selective fetal reduction by embryo aspiration can be administered as one of the effective therapies for HP with the optimal outcome of intrauterine pregnancy.

A 39 year-old woman with previous salpingectomy developed a symptomatic heterotopic right cornual pregnancy identified by transvaginal ultrasonography at six weeks' gestation. The patient had previously undergone an ipsilateral partial salpingectomy, and the conception was established four months later after one cycle of controlled ovarian hyperstimulation, in vitro fertilization (IVF) and embryo transfer. We performed immediate surgical excision of the ectopic implantation with conservation of the intrauterine pregnancy. Progesterone was administered as 200 mg/d lozenge (troche) plus 200 mg/d rectal suppository, maintained from day of embryo transfer through the perioperative period and until 11th gestational week. Following an uneventful obstetrical course, a healthy male infant was delivered by cesarean at term. In this report, we review the incidence and significance of heterotopic gestation in the context of IVF/embryo transfer. Risk factors for complex intra- and extra-uterine pregnancies are also outlined. Additionally, the clinical management of heterotopic pregnancy, including a novel approach to progesterone supplementation, is discussed.