Clinical Outcomes of Patients With Heterotopic Pregnancy After Surgical Treatment.

STUDY OBJECTIVE: To review the surgical management and clinical outcomes of patients with heterotopic pregnancy (HP) who underwent in vitro fertilization and embryo transfer (IVF-ET) and surgical treatment between January 2010 and December 2015.

DESIGN: Retrospective clinical analysis (Canadian Task Force classification II).

SETTING: Assisted Reproductive Technology Center of Peking University Third Hospital.

PATIENTS: Fifty-six patients with HP who underwent IVF-ET and surgical treatment between January 2010 and December 2015.

INTERVENTIONS: In 56 patients, we retrospectively analyzed general characteristics, diagnostic features, surgical management, and clinical outcomes based on medical records and follow-up telephone interviews. All 56 patients had undergone transvaginal sonography on the day of admission. Fifty-four 54 patients had undergone laparoscopic surgery. Two patients with suspected heterotopic cervical pregnancy had undergone extraction with forceps and curettage under abdominal ultrasound guidance.

MEASUREMENTS AND MAIN RESULTS: The incidence of HP was significantly lower in frozen-thawed embryo transfer cycles compared with fresh embryo transfer cycles (29 of 13 128 [0.22%] vs 124 of 22 327 [0.56%]; p = .000). The live birth rate was 75.0% without congenital abnormalities, and the miscarriage rate was 17.86%. There were no significant differences in the rates of miscarriage (p = .08) and preterm delivery (p = .39) among different positions of heterotopic tubal pregnancy. There were no significant differences in general characteristics, diagnostic features, and intraoperative findings between the miscarriage and non-miscarriage groups, or between the preterm and term delivery groups.

CONCLUSION: The incidence of HP has risen dramatically with the widespread application of assisted reproductive technology, and the diagnosis and management of HP remain challenging. With increased awareness of HP in patients who have undergone IVF-ET, early diagnosis and appropriate surgical treatment may lead to a favorable prognosis.