[Heterotopic pregnancy as an complication during pregnancy and labour--the case report]

Heterotopic gravidity (HG) is a rare co-existence of intrauterine and ectopic pregnancy with higher incidence in pregnancies after in vitro fertilisation (IVF). Diagnosis of HG is demanding. HG is commonly identificated when rupture or hemoperitoneum occurs.

35-year-old woman after 3rd cycle of IVF for absolute tubar factor. Two embryos transfered. Ectopic implatation of second embryo in uterine corner occured. Patient hospitalized with acute deteriorating symptoms of hemoperitoneum in 6th week of gestation. Diagnostic laparoscopy performed with ectopic cornual gravidity detection. Decision made to retain the intrauterine gravidity. Induction of the labour in the 40th week of gestation performed. Placenta retained after the delivery of a normal newborn. Lysis manualis performed, uterine hypothonia followed. On suspicion of placenta percreta laparotomy indicated. Acute supracervical abdominal simplex hysterectomy performed. Histologic examination confirmed the diagnosis of placenta percreta.

The diagnosis of HG is based on the assesment of clinical symptoms, transvaginal ultrasound and endoscopic diagnostics with eventual intervention. In case of hemoperitoneum urgent surgical intervention indicated. Placenta percreta is a rare complication increased in incidence by the presence of myometrial dammage usually from past uterine surgery. Presence of the scar tissue and abnormal placentation might also be a random coincidence. Placenta percreta is a life threatening complication with a great risk of hemmorhage and commonly requires acute surgical intervention.