Navigating Diagnostic Challenges: Heterotopic Pregnancy Versus Hyperdecidual Reaction in Ectopic Gestation

Area of Science:

• Obstetrics and Gynecology
• Reproductive Medicine
• Diagnostic Imaging

Background:

• Heterotopic pregnancy, a rare condition with simultaneous intrauterine and ectopic pregnancies, poses diagnostic challenges.
• Symptoms often mimic normal intrauterine or isolated ectopic pregnancies, complicating timely intervention.
• Hyperdecidual reaction within the uterus can be mistaken for an intrauterine pregnancy, further confusing diagnosis.

Observation:

• A case is presented where an ectopic pregnancy was radiologically misdiagnosed as a heterotopic pregnancy.
• The misdiagnosis was attributed to a significant hyperdecidual reaction within the uterus.
• The patient underwent laparoscopic salpingectomy for tubal ectopic pregnancy and D&E for suspected failed intrauterine pregnancy.

Findings:

• Histopathological examination of the intrauterine products confirmed decidua without trophoblastic tissue, ruling out an intrauterine pregnancy.
• This finding indicates the initial radiological diagnosis of heterotopic pregnancy was incorrect.
• The case underscores the importance of histopathological confirmation in complex pregnancy diagnoses.

Implications:

• Accurate differentiation between these pregnancy types is crucial for appropriate patient management and outcomes.
• Awareness of hyperdecidual reaction mimicking intrauterine pregnancy is vital for avoiding misdiagnosis.
• This case emphasizes the need for careful interpretation of imaging and definitive histopathological analysis in suspected complex pregnancies.