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Spontaneous angular dichorionic diamniotic twin pregnancy: a case report.

Maria Papiccio1, Anna Chiara Boschi1, Filippo Ferrara1

  • 1Obstetrics and Gynecology, Hospital "S. Maria delle Croci," Ravenna, Italy.

Fertility and Sterility
|December 28, 2021
PubMed
Summary

This case report highlights the successful ultrasound diagnosis and conservative management of a rare spontaneous angular twin pregnancy. Early detection enabled prompt treatment, preventing severe complications in a high-risk patient.

Keywords:
Ectopic pregnancyangular pregnancyinterstitial pregnancyobstetric complicationsobstetric ultrasound

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Area of Science:

  • Obstetrics and Gynecology
  • Radiology
  • Reproductive Medicine

Background:

  • Angular pregnancy, often confused with interstitial or cornual pregnancies, presents diagnostic challenges.
  • Accurate differentiation of ectopic pregnancies is crucial for appropriate management strategies.

Observation:

  • A 28-year-old patient with prior cesarean delivery presented with a presumed angular ectopic pregnancy.
  • Transvaginal ultrasound revealed a dichorionic diamniotic twin pregnancy in the right uterine angle, with one sac angularly implanted and the second deeply embedded in the myometrium (3mm margin).

Findings:

  • Early and accurate ultrasound diagnosis of this high-risk angular twin pregnancy was achieved.
  • Conservative medical management, including methotrexate and subsequent hysterosuction, resulted in successful termination.
  • Serum beta-human chorionic gonadotropin levels normalized, and menstrual bleeding resumed within one month post-treatment.

Implications:

  • This case underscores the importance of precise ultrasound criteria for diagnosing angular pregnancies.
  • Timely diagnosis and individualized management are essential to mitigate the risks and potential severe complications associated with angular pregnancies.
  • Advances in ultrasound technology aid in managing complex ectopic gestations.