Live Unilateral Ectopic Twin Pregnancy in a 29-Year-Old Primigravid Woman: A Case Report and Literature Review
Dominika Trojnarska1, Magdalena Kołak2, Robert Jach3
1Department of Maternal and Child Health, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Cracow, Poland.
BACKGROUND This report describes the rare occurrence of a unilateral live tubal twin ectopic pregnancy, diagnosed by transvaginal ultrasound and confirmed surgically. This case is presented to emphasize diagnostic and management challenges. CASE REPORT A 29-year-old primigravid woman at 5 weeks and 6 days by last menstrual period was referred with a suspected pregnancy of unknown location. She was asymptomatic, and vital signs were within normal limits. Her medical history was unremarkable except for ovulation induction with letrozole and clomiphene. Serum beta-human chorionic gonadotropin (ß-hCG) measured 7385 mIU/mL. On examination, the uterus was slightly enlarged without palpable masses. Ultrasound revealed an inhomogeneous endometrium with a pseudogestational sac. In the right adnexa, 2 live ectopic pregnancies were identified, each with a yolk sac, crown-rump length consistent with 6 weeks of gestation, and detectable fetal cardiac activity. A small amount of free fluid was observed in the pelvis. Laparoscopy confirmed a right tubal twin ectopic pregnancy. Right salpingectomy was performed, and histopathologic examination confirmed a tubal pregnancy without additional abnormalities. The patient recovered uneventfully and was discharged on postoperative day 1 with ß-hCG level of 1962 mIU/mL. At follow-up 1 week later, examination findings were unremarkable; the ß-hCG level had declined to 237 mIU/mL. CONCLUSIONS A review of the available English-language literature confirms the rarity of live twin ectopic pregnancy. In the absence of specific management guidelines, treatment principles for singleton ectopic pregnancy should be applied. Based on published literature and our experience, laparoscopic salpingectomy is the preferred therapeutic approach.
BACKGROUND This report describes the rare occurrence of a unilateral live tubal twin ectopic pregnancy, diagnosed by transvaginal ultrasound and confirmed surgically. This case is presented to emphasize diagnostic and management challenges. CASE REPORT A 29-year-old primigravid woman at 5 weeks and 6 days by last menstrual period was referred with a suspected pregnancy of unknown location. She was asymptomatic, and vital signs were within normal limits. Her medical history was unremarkable except for ovulation induction with letrozole and clomiphene. Serum beta-human chorionic gonadotropin (ß-hCG) measured 7385 mIU/mL. On examination, the uterus was slightly enlarged without palpable masses. Ultrasound revealed an inhomogeneous endometrium with a pseudogestational sac. In the right adnexa, 2 live ectopic pregnancies were identified, each with a yolk sac, crown-rump length consistent with 6 weeks of gestation, and detectable fetal cardiac activity. A small amount of free fluid was observed in the pelvis. Laparoscopy confirmed a right tubal twin ectopic pregnancy. Right salpingectomy was performed, and histopathologic examination confirmed a tubal pregnancy without additional abnormalities. The patient recovered uneventfully and was discharged on postoperative day 1 with ß-hCG level of 1962 mIU/mL. At follow-up 1 week later, examination findings were unremarkable; the ß-hCG level had declined to 237 mIU/mL. CONCLUSIONS A review of the available English-language literature confirms the rarity of live twin ectopic pregnancy. In the absence of specific management guidelines, treatment principles for singleton ectopic pregnancy should be applied. Based on published literature and our experience, laparoscopic salpingectomy is the preferred therapeutic approach.
