J Korean Soc Med Ultrasound.  1999 Mar;18(1):33-38.

Heterotopic Pregnancy: Sonographic Findings

• Kwon TH

Abstract

PURPOSE: To evaluate the sonographic findings of the heterotopic pregrancy which is increasing recently.
MATERIALS AND METHODS
Thirty-nine cases of heterotopic pregnancy after ovulation induction and IVF-ET (In Vitro Fertilization-Embryo Transfer) during the recent 3 years were analyzed. They were diagnosed by ultrasonography and proved surgically afterwards. Sonographic findings were analyzed focusing on gestational week of intrauterine pregrancy and location of ectopic pregrancy. In particular, adnexal mass was evaluated with regard to size and the characteristic findings such as ectopic gestational sac (echogenic ring). Also, overian cyst and fluid collection in cul-de-sac space were reviewed carefully. Heterotopic pregnancy was proved surgically by salpingectomy in 33 cases and by resection of cornus in six cases.
RESULTS
Sonographic diagnosis using transvaginal ultrasound was made from five weeks to nine weeks two days (six weeks and four days in average) from last menstral period in all 39 cases. Ectopic pregnancy was identified in ampullary part in 29 cases, in the isthmic portion of tube in four cases and in the cornus of uterus in six cases. The intrauterine pregrancy was diagnosed by identifying the intrauterine gestational saccontaining a yolk sac in seven cases and the embryo with fetal heart beat in the remaining 32 cases. Adenxal masses of heterotopic pregnancy were less than 3cm in diameter in 2 cases (57%), 3-4cm in 11cases (28%) and more than 4cm in 6 cases (15%). A characteristic finding of ectopic mass was echogenic ring which was visible in 33 (84.6%) cases by transvaginal ultrasound. Six cases had pelvic hematosalpinx and two had pelvic hematoma. Of 10 cases (26%) which were identified to have ovarian hyperstimulation syndrome, eight (21%) had large amount of fluid collection in cul-de-sac and abdomen.
CONCLUSION
Ultrasonographic identification of the intrauterine pregnancy and the ectopic chorion ring is effective for the early diagnosis of the heterotopic pregnancy.

MeSH Terms

Abdomen
Chorion
Cornus
Diagnosis
Early Diagnosis
Embryonic Structures
Female
Fetal Heart
Gestational Sac
Hematoma
Ovarian Hyperstimulation Syndrome
Ovulation Induction
Pregnancy
Pregnancy, Ectopic
Pregnancy, Heterotopic*
Salpingectomy
Ultrasonography*
Uterus
Yolk Sac