Female reproductive system is so interconnected that all processes in the period of gestation are aimed at the fetus’s proper development and preservation. However, in some situations, due to certain circumstances, an abnormal attachment of the zygote outside the uterus can take place. This situation is determined by ectopic pregnancy. But, there are more difficult situations, when there is a simultaneous normal pregnancy and an ectopic one. This is called heterotopic pregnancy. What to do with the heterotopic development of the fetus? Is it possible to preserve a normal pregnancy?
What Is Heterotopic Pregnancy?
Heterotopic pregnancy is a condition in which the uterine and ectopic localization of fetal eggs occurs simultaneously. This type of pathology occurs in 1-3% of all cases of in vitro fertilization, and with a frequency of 1: 30,000 from all cases of natural conception.
Heterotopic pregnancy is quite a rare phenomenon. Often, uterine and ectopic pregnancy simultaneously develops after artificial conception in a laboratory, when several zygotes are inserted into the uterus at a time. Until they are implanted, one of them can migrate into a fallopian tube or cervical canal and settle there. It can also develop after induction of ovulation or after taking medications that affect the function of the childbearing system. In addition, it can be genetically determined.
The localization of ectopic zygotes can be observed:
- in the peritoneum;
- in the ovaries;
- or in the tubes.
There were cases when oocytes implanted in the uterus and beyond its limits were fertilized in different menstrual cycles. For example, the age of a zygote attached outside the uterine cavity was 5-6 weeks, and the duration of a normal pregnancy was only 14 days. This is possible if a woman has a short regular period.
At the beginning, heterotopic pregnancy, as well as an ectopic one does not differ from a healthy pregnancy. It can be accompanied by the following symptoms:
- absence of menstruation, positive pregnancy test;
- nausea and vomiting;
- change in taste preferences, intolerance to certain products, odors;
- swelling and tenderness of the mammary glands;
- frequent urge to urinate;
- emotional lability.
As the trophoblast grows outside the uterus, the following clinical manifestations of an abnormal pregnancy can be noted:
- Stretching pains in the lower abdomen, which can irradiate in the lower back or in the sacrum;
- Also, there may be bloody discharge from the vagina. Often the swelling is observed after sexual intercourse;
- Asthenia, nausea, vomiting, vertigo.
If you have these symptoms, do not postpone the visit to the doctor. The delay in this case can cost you your life.
Why Is Uterine and Ectopic Pregnancy Take Place Simultaneously?
While many women know about ectopic pregnancy, a concept such as heterotopic embryo development raises many questions and concerns. It is difficult to imagine such fertilization. It is even more difficult to react normally to it in case of a long-awaited positive result on the test. However, heterotopic pregnancy takes place only in 1 out of 30 000 pregnancies.
Like any other pathology of fetal development, the heterotopic attachment of the embryo has its own risk group for women who are prone to the formation of multiple pregnancies outside the uterus more often than others.
Women after 45
After 45 years, the reproductive function of a woman naturally decreases. There is a violation of the menstrual cycle, the discharges change their character, the cycle becomes longer and then disappears at all. However, at this age, the fertilization of the released egg may still occur. Simultaneously, normal and ectopic or heterotopic attachment of the zygote also happens more often.
After 45 years, doctors observe pregnant women more carefully, as the risk of genetic diseases of the fetus increases by 45%, the anomaly of chromosome formation by 50%, and other complications by 30%.
With artificial insemination, the chance of abnormal pregnancy development increases. Doctors always warn about it. Multiple fertilization occurs 40% more often with IVF than with a natural process.
Adhesive Process in the Organs of the Small Pelvis
The formation of scarring on the organs of the reproductive system of a woman reduces the likelihood of fertilization in itself. Adhesions on tubes cannot be treated and cannot be removed by a surgery.
Stimulation of ovulation means taking special medications that increase the risk of forming both a multiple pregnancy and a heterotopic one. There are studies in which the heterotopy of the fetus is observed more often on the background of taking Clomifene or Clostilbegyt.
Women who have frequent cases of multiple fertilization in the family are at risk. However, this does not mean that all women with such heredity should worry about the abnormal attachment of the zygote.
Multiple fetuses are transmitted only by the maternal line. If a husband has multiple births in the family, this does not mean that a similar situation can occur in his own family.
The progression of ectopic fetal attachment is accompanied by simultaneous and characteristic symptoms of an ectopic pregnancy:
- pain from one side of the abdomen shifts to the intestine, rectum or back;
- painful sensations increase in the lower back;
- there is a cold sweat.
Heterotopic Pregnancy Signs
Signs of a dangerous condition for a woman vary depending on the period of gestation. If a pregnant woman visits the gynecologist, knows about the presence of a normal pregnancy, then when the first anxious symptomatology appears it is worth consulting a doctor.
In case of heterotopic development of embryos, the hCG level increases faster. What’s more, its concentration is two times higher than in a single pregnancy. At the same time, hCG level in this case is lower than while bearing twins.
Is It Possible to Save an Abnormal Pregnancy?
Can an ectopic pregnancy be saved? No, the zygote implanted in the oviduct, ovary or abdominal cavity grows, stretches and traumatizes nearby tissues. As a result it leads to internal bleeding.
With such pathology, the surgery should be performed as soon as possible. Thus, there is a chance to save the fallopian tube, although usually the oviduct is amputated along with the fetal egg.
As a rule, a laparoscopic surgery is performed. During the procedure, 3 punctures are made on the anterior wall of the abdomen and the embryo is removed from the fallopian tube using vaccum aspiration. After such treatment, a woman can return to normal life in 10 days. Experts recommend planning a new conception only in 6-12 months. However, the time in each case should be discussed with the doctor individually. If a woman feels well and there are no complications, she can be allowed to begin planning conception in the first cycle after the laparoscopy.
Can ectopic pregnancy shift to the uterus?
No, it is impossible. Therefore, if such an anomaly is found, surgical treatment should not be postponed. Delay in this case is very dangerous, it can even lead to death. Therefore, if a woman suspects the development of an abnormal pregnancy, she should consult a doctor or make an ultrasound. It is recommended to visit a doctor on the 5th-6th day after a delay in menstruation. At this time it is already possible to reveal the development of pathology, and you should not refuse hospitalization.
Currently, thanks to assisted reproductive methods, many women who have experienced an ectopic pregnancy and an operation to remove the fallopian tubes and ovaries become pregnant and give birth to healthy children. Therefore, do not despair. It is better to put your efforts for preparing for bearing a child: to give up bad habits, undergo a course of rehabilitation after surgical treatment, to take vitamin and mineral complexes for pregnant women (only after consulting a specialist), rest, and eat well.