What is a Heterotopic pregnancy?

Heterotopic Pregnancy Complete Fact Sheet

Heterotopic Pregnancy Complete Fact Sheet

How does pregnancy occur?

Pregnancy is a natural phenomenon that brings joy for many couples for the addition of another human to their family. The pregnancy is, however, a complex occurring as well as a miracle and a woman has to go through multiple phases during her pregnancy till the birth of the child.

Pregnancy occurs as a result of an implantation of a fertilized egg. The egg that has been released by the ovary, like it does every month, gets fertilized by a male sperm after an act on intercourse. Once the egg has been fertilized it will now be referred to as a zygote. The zygote travels down the fallopian tube, where the fertilization takes place, and in another 10 days travels to the uterus for its attachment. 

After the zygote has attached to the wall of the uterus, the actual growth of the zygote commences from here. But many things can go wrong while the implantation has occurred, continue reading the article to know one of the many things that can go wrong with implantation.

What is a Heterotopic pregnancy?

Heterotopic pregnancy is defined as two zygote implantation that occurs at the same time but in different locations. One zygote implants in its usual site that is the uterus while the other zygote implants in any location other than the uterus, it can be the ovaries, the pouch of Douglas or even the Fallopian tube which is the most common site and such pregnancy is known as ectopic pregnancy, where a zygote attaches itself outside the cavity of the uterus.

Although heterotopic pregnancy is very rare, the health risk to a woman are high, in comparison to ectopic pregnancy alone which is rather common. The rate of heterotopic pregnancy is as high as 7000 pregnancies in 30,000 pregnancies, and the considerably large number of heterotopic pregnancies are a result of In Vivo Fertilization or IVF.

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What are the symptoms of a heterotopic pregnancy?

A heterotopic pregnancy has to be ruled out but there are no symptoms that are unique to heterotopic pregnancy. The symptoms are very vague and may present as any other disease or complication which makes it hard to differentiate especially is a woman has an only ectopic pregnancy.

Here is a list of symptoms a person may present with if she has heterotopic pregnancy:

  • Pain in the pelvic region
  • Fainting or syncope
  • Dizziness
  • Nausea and vomiting
  • Bloating
  • Unusual vaginal bleeding, in cases of ruptured tube


How to diagnose heterotopic pregnancy?

Heterotopic pregnancies are largely found on trans-vaginal ultrasound. But due to the rarity of the complication, a heterotropic pregnancy can easily be missed on radiology as the radiologist my primarily be looking at the uterus to see for the fetus and may not check elsewhere for the source of pain or bleeder which may be caused by heterotopic pregnancy.

And if any abnormality is found in the other structures, then the radiologist will determine if the sac has fetal tissues or if the sac is empty to label it as an ectopic pregnancy.

Similarly, it is also very hard to diagnose heterotopic pregnancy in the early stages of pregnancy as the growing fetus may not become visible on the ultrasound until the 5th or 6th week of gestation is reached. Before this, the blood test for HCG hormone may be used for a provisional diagnosis, which is a hormone released by the growing fetus to maintain the pregnancy.

Your doctor may check the rising levels of HCG to determine the growth of the fetus of the ectopic pregnancy before the ultrasound results come out.


What is the treatment for heterotopic pregnancy?

The medical treatment may not be as useful in heterotopic pregnancies as it is in ectopic pregnancy alone. Because the medications potentially stop the fetus from developing and in heterotopic pregnancy another fetus is growing in the uterus and there are chances that the fetus may grow till its term and get delivered so giving such medications can bring harm to the fetus rowing normally in the uterus.

The definite treatment for a heterotopic pregnancy is to remove the tissue where the zygote is surviving. In case, the pregnancy prolonged in the same site, it could be a potential health risk for the mother and can even be fatal. Therefore, the mother must undergo surgery to get the fetal tissue removed. The site and the implantation of the zygote also determine what type of a surgery the mother requires or whether or not the mother’s tissues have to be removed.

In most cases, the fetal tissues are removed without excising the mother’s structures and in other cases, the structures have to be removed either because the zygote has developed a lot or the implantation is in such a complicated site the mother’s tissue has to be removed and this is the last resort.

Either way, the zygote has to be removed because the zygote can not develop in any other site but the uterus, and also because the mother is at a risk. Plus, if the heterotopic pregnancy ruptures because it stretched the mother’s tissue at an abnormal extent then the mother will experience a heavy bleeding and a massive hemorrhage may lead to shock and even death if not treated on time.

At times, doctors are able to save the uterine fetus while they are removing the ectopic pregnancy. This means in 67 percent of the cases; the mother is able to take her uterine pregnancy to term. But the fact that in many cases mothers lose both of her fetuses can cause devastating emotional aftermath on her mental health and she must get support from the people around her to help her get through this.

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How to prevent heterotopic pregnancy?

There is often no possible way to prevent yourself from heterotopic pregnancy. The most common reason for heterotopic pregnancy is the fertility procedure where the egg is induced in the uterus, and it is hard to prevent such pregnancies after inductions, as more than one egg has to be induced for at least one of them to survive, albeit, there are some measures you can take to diminish the causes that lead to heterotopic pregnancy.

  • You can reduce the chances by taking the right measures for reducing the transmission of Sexually Transmitted Diseases (STDs) that can potentially render you to conceive in abnormal sites.
  • Quit smoking if you do.
  • Get your pelvic infections treated before you try to conceive.
  • Take the right measures by asking your doctor if you have had an ectopic pregnancy before and how to prevent it from happening again.
  • Make regular visits to the doctor while your pregnancy so that any complication is diagnosed before it gets too late.


Chances of conceiving after a heterotopic pregnancy:

Many women are able to conceive after their heterotopic pregnancies and carry their fetuses to term and deliver normal and healthy babies. This is not uncommon and you can conceive in many instances even if you have only one ovary and fallopian tube intact, even though the chances of fertility reduce by half because you lost one of your fallopian tubes, but it is never impossible to become pregnant again and deliver normal babies unless you had some structural abnormality before or some fertility issues then your chances of conceiving drops even more. Nonetheless, there are high chances that you will become a mother if you never had any fertility issues before your heterotopic pregnancy.

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