A Case Study of Heterotype

Introduction: Hetrotype pregnancy has been defined as coexistence of intrauterine and ectopic pregnancy. Coexistence of intrauterine and ovarian pregnancy is rare and often occurs in women who use Intrauterine Device (IUD) or women under assisted reproductive technology. We report a patient who presented with abdominal pain and an adenexal mass in ultrasound scanning. Post operation diagnosis was coexistence of intrauterine and ovarian pregnancy.

Case Report: The case was a 29 year – old woman G4P3 who presented with abdominal pain ,nausea, vomiting, and 4 month history of menstruation retard and 2 month history of spotting. On physical examination, her uterine was about 18^th week of pregnancy. There was abvious tenderness in LLQ. A firm mass estimated about 3Cm was palpable. In clinical and paraclinic evaluations she had 17 weeks intrauterine pregnancy and a left adenexal  mass with 7.5 weeks pregnancy sac without heart rate. Post operation pathological examination revealed heterotype pregnancy with ovarian pregnancy.

Discussion: Heterotype pregnancy is rare and vast majority of cases are coexistence of tubal and intrauterine pregnancy. Coexistence of intrauterine and ovarian pregnancy is very rare. Probably, predisposing factor in our patient was the use of intra-uterine device (IUD). Recently ,this has been reported frequently in cases of ovarian heterotype pregnancy. In this patient, ovarian tissue was seen around the pregnancy sac . The most common symptom is abdominal pain followed by delay in menstruation cycle and spotting. Diagnosis of ovarian pregnancy accompanied by intrauterine pregnancy is difficult. In this situation serial measurment of  hcG is not useful Since intrauterine pregnancy cause appropriate rise in hcG concentration. On the other hand, ultrasonography may show false negative results in the detection of ectopic pregnancy or make incorrect diagnosis of corpus louteum cyst.