42.     Heterotopic pregnancy.



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a. is pregnancy conceived by a lesbian mother using sperm from a homosexual donor. False
b. is pregnancy in a woman with asthma and eczema. False
c. Is most common after assisted reproduction. True
d. presents particular diagnostic dilemmas. True


Heterotopic pregnancy is pregnancy in more than one site.


Usually this means one in the uterus and one in the tube.


You might think that this is so esoteric that it is time to yawn and move on.




Read on. This is something you could easily have to deal with.



It is a great rarity in nature. Not so after assisted reproduction Ė IVF etc. (See MCQ6, question 35.)


The natural incidence is put at 1: 10 - 50,000.


But after IVF the incidence is 1: 100!


IVF is very common and may become more so - NICE has recommended that most infertile women should have access to it.


This means that heterotopic pregnancy is something you could easily encounter, either as an SHO or as a GP.


At the March 06 course, Emma, one of the roleplayers, was in early pregnancy, having had surgery to deal with a heterotopic tubal pregnancy.


She had not had IVF and had no risk factors for ectopic pregnancy.


Stuff it in the old memory bank!


The ongoing intrauterine pregnancy is going to provide normal HCG levels and the scan will show an intrauterine sac and eventually a viable intrauterine pregnancy.


The diagnosis will usually be clinical - suspicion of ectopic pregnancy - unless the scan shows an adnexal mass or blood in the pouch of Douglas.


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