Heterotopic Pregnancy

Every pregnancy can be unique and challenging; some can even be dangerous. It is important to understand what kind of pregnancy you are a part of as some of these could be a challenge to see out to term while other pregnancies can offer unique dilemmas. The circumstances of these pregnancies have dire consequences unless the correct kind of care is taken.

What is Heterotopic Pregnancy?

In the circumstance that pregnancy has multiple foetuses, there can be a situation where one of these foetuses is outside the uterus and inside a fallopian tube, this is known as a non-viable Ectopic Pregnancy. The foetus that forms within the uterus is considered an intrauterine pregnancy. A pregnancy where both a non-viable ectopic pregnancy and an intrauterine pregnancy exist simultaneously (where one foetus is in the uterus, and another is outside) is known as a heterotopic pregnancy. This kind of pregnancy is rare but is as dangerous as an ectopic pregnancy where only one foetus exists, and it is outside the uterus.

How Common Is it?

As mentioned above, this type of pregnancy is not common. According to doctors, any pregnancy that is part of natural conception or spontaneous conception, more commonly referred to as sexually viable pregnancies is less at risk for heterotopic pregnancies, the chances of such a pregnancy occurring is 1 in 30,000 couples if neither partner was part of a heterotopic pregnancy and 1 in 10,000 in couples that may have a partner who may have been part of a heterotopic pregnancy during their infancy. In artificial conception methods like IVF or external conception methods like surrogacy pregnancies, the rate can drastically increase but is still only 2 in every 1000 assisted pregnancies.

Causes

The causes of heterotopic pregnancy can be hard to identify; doctors still are trying to understand what the root causes of this condition are. Here are a few of the known guidelines that may lead to heterotopic pregnancies:

• History of the pelvic inflammatory disease can increase the risk of heterotopic pregnancies.
• Assisted pregnancies can cause this condition.
• Surgical treatments for infertility can cause this condition as a side-effect.
• During IVF, the force generated due to the procedure can lead to this condition.

Signs and Symptoms

As with any condition, it is crucial to understand what the signs and symptoms are. Here are some heterotopic pregnancy symptoms:

• Abnormal and excessive vaginal bleeding
• Severe or mild abdominal pain that is persistent during the pregnancy
• Pain on the sides of the upper torso that is constant and unbearable
• Extreme or unusual bloating
• Constant dizziness or lightheadedness
• Severe nausea
• Constant vomiting
• Vomiting blood
• Fainting on a regular basis

If you experience these signs and symptoms, please consult your medical professional immediately.

Diagnosis

For a doctor to be able to come to a diagnosis of heterotopic pregnancy some guidelines and markers have to be met, here are a few of these:

• For the first three weeks of the pregnancy, doctors will monitor any suspected cases with blood tests.
• The most conclusive way of making a diagnosis can only happen through an ultrasound; this can only happen a month into the pregnancy.
• Routine urine tests may also help with the diagnosis.
• Although the symptoms can be clear, they can be part of multiple diagnoses, until the ultrasound is done, doctors will monitor and treat expectant mothers carefully if they suspect heterotopic pregnancy is a real risk

Treatment

Unfortunately, the risk that a foetus, that is outside the uterus, poses to the intrauterine pregnancy and the mother is incredibly high, this is why the only way to successfully ensure the survival of the mother and the other foetus is by terminating the outer foetus through surgery. Although this can be painful, the sad fact is the other foetus has no chance of surviving if outside the uterus, currently there are no other heterotopic pregnancy treatment options.

Risks and Complications

Some couples face a dilemma of terminating the baby; understanding the risks and complications of attempting to carry the baby to term can help explain why this option is necessary. Most heterotopic pregnancy complications can be so extreme it can lead to fatal outcomes for both the foetuses and the mother, at the very least, the chances of a miscarriage is extremely high, it can almost be considered a certainty. An additional risk is that carrying the foetuses to term could harm the mother’s body to an extent where she may never be able to live without assistance. One thing to consider here is that the foetus outside the uterus has no chance of survival, the uterus is an environment that is specifically designed to house and nurture a foetus, a fallopian tube cannot do the same. In most cases, a mother can successfully deliver the intrauterine foetus in a healthy and safe manner.

It is perfectly normal for mothers to undergo a depressive phase when the termination is done, this is why your medical specialist will recommend counselling. Even if the other foetus is successfully delivered, it is common and normal for the mother to grieve the terminated foetus, to help manage this loss, you can ask your doctor for the number of support groups and grief counsellors, it is important to see a psychologist and attend regular counselling sessions regularly with your partner, they may be grieving as well.