Heterotopic pregnancy: current aspects of diagnosis and treatment

Abstract

Objective. To analyze current literature on the diagnosis and treatment of heterotopic pregnancy (HP) and to present a clinical case. Materials and methods. A total of 98 publications from the PubMed and eLibrary.ru databases issued between 2000 and 2025 were reviewed. In addition, a clinical case of HP following in vitro fertilization (IVF) is presented. Results. HP remains a rare but potentially life-threatening condition, and its incidence has increased significantly in the era of assisted reproductive technology (ART). In natural cycles, HP occurs in 1:30,000–1:10,000 cases, whereas after IVF, its incidence may reach up to 1% of pregnancies. The main risk factors for HP include the use of ART, pelvic inflammatory disease, endometriosis, and previous fallopian tube procedures. The key diagnostic criteria are an abnormal serum chorionic gonadotropin (β-hCG) trend in the presence of intrauterine pregnancy confirmed by ultrasound, along with the detection of atypical adnexal masses. In the presented clinical case, a 38-year-old patient developed a left-sided tubal pregnancy after the transfer of a single embryo, occurring concurrently with resorption of the intrauterine gestational sac. Laparoscopic salpingectomy was performed. Conclusion. The signs of intrauterine pregnancy does not exclude a heterotopic location of the second gestational sac, especially in high-risk patients. Transvaginal ultrasound combined with dynamic monitoring of β-hCG is the cornerstone of diagnosis. Early detection and timely management of patients with HP allow preservation of the intrauterine pregnancy in 70–85% of cases and help to prevent serious complications. Key words: heterotopic pregnancy, ectopic pregnancy, assisted reproductive technology, IVF, transvaginal ultrasound, β-hCG, laparoscopy, salpingectomy