Undiagnosed Heterotopic Pregnancy, Maternal Hemorrhagic Shock, and Ischemic Stroke in the Intrauterine Fetus

Abstract Heterotopic pregnancy occurs rarely following natural conception; however, intrauterine embryo transfer following IVF is a known risk factor for its occurrence. A 29‐year‐old woman presented with acute abdomen at 14w5d gestation following IVF‐ET treatment. A ruptured heterotopic gestation in the left fallopian tube was identified at laparoscopy and treated by salpingectomy. Subsequently, at 21‐week gestation, routine sonogram demonstrated bilateral ventriculomegaly in the intrauterine fetus. Fetal MRI was highly suggestive of ischemic brain injury, most likely attributable to the maternal hypovolemic shock due to ruptured heterotopic gestation. The pregnancy was terminated by intra‐cardiac injection and induction of labor. Timely diagnosis of heterotopic pregnancy requires a high index of suspicion as diagnostic delays can have catastrophic consequences for the mother and/or the intrauterine fetus.
Source: Prenatal Diagnosis - Category: Perinatology & Neonatology Authors: Tags: Research Letter Source Type: research