Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 May 12;57(5):483.
doi: 10.3390/medicina57050483.

Heterotopic Quadruplet Pregnancy. Literature Review and Case Report

Brîndușa Cimpoca  1 , Amira Moldoveanu  2 , Nicolae Gică  1   3 , Corina Gică  3 , Anca Marina Ciobanu  3 , Anca Maria Panaitescu  1   3 , Dana Oprescu  1   2
Affiliations
Review

Heterotopic Quadruplet Pregnancy. Literature Review and Case Report

Brîndușa Cimpoca et al. Medicina (Kaunas). .

Abstract

Heterotopic pregnancy is the condition where both intrauterine and ectopic pregnancy are present. It rarely occurs after natural conception, but is more common with assisted reproductive techniques, when more than one embryo is transferred. Quadruplet heterotopic pregnancy is exceedingly rare.

Methods: A literature review was conducted aiming to highlight the diagnosis difficulties and the management options in heterotopic quadruplet pregnancies.

Results: Nine relevant studies were identified by researching PubMed up to 2021 for "heterotopic quadruplet pregnancy", "quadruplet intrauterine and ectopic pregnancy", "synchronous intrauterine and ectopic pregnancy".

Conclusions: In this paper, we present a case of heterotopic quadruplet pregnancy and address the difficulty in diagnosing this condition and make formal recommendations.

Keywords: heterotopic quadruplet pregnancy; quadruplet intrauterine and ectopic pregnancy; synchronous intrauterine and ectopic pregnancy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Transabdominal scan at 9 weeks of pregnancy confirms a trichorionic triamniotic (TCTA) pregnancy. Clear visualization of the two lambda signs and thick intertwin membranes, composed of a central layer of chorionic tissue sandwiched between two layers of amnion, therefore multi-layered, more echogenic.
Figure 2
Figure 2
Intraoperative aspects: (a) Direct visualization of the ruptured fallopian tube during laparotomy; (b) unilateral salpingectomy was performed, and overall blood loss was 1500 mL.
Figure 3
Figure 3
Flowchart on decision making after confirming an intrauterine pregnancy and assessment of pelvic organs.
See this image and copyright information in PMC

References

    1. Luo X., Lim C.E., Huang C., Wu J., Wong W.S., Cheng N.C. Heterotopic pregnancy following in vitro fertilization and embryo transfer: 12 cases report. Arch. Gynecol. Obstet. 2009;280:325–329. doi: 10.1007/s00404-008-0910-2. - DOI - PubMed
    1. Chin H.Y., Chen F.P., Wang C.J., Shui L.T., Liu Y.H., Soong Y.K. Heterotopic pregnancy after in-vitro fertilization–embryo transfer. Int. J. Gynecol. Obstet. 2004;86:411–416. doi: 10.1016/j.ijgo.2004.05.011. - DOI - PubMed
    1. Reece E.A., Petrie R.H., Sirmans M.F., Finster M., Todd W.D. Combined intrauterine and extrauterine gestations: A review. Am. J. Obstet. Gynecol. 1983;146:323–330. doi: 10.1016/0002-9378(83)90755-X. - DOI - PubMed
    1. Refaat B., Dalton E., Ledger W.L. Ectopic pregnancy secondary to in vitro fertilization-embryo transfer: Pathogenic mechanisms and management strategies. Reprod. Biol. Endocrinol. 2015;13:30. doi: 10.1186/s12958-015-0025-0. - DOI - PMC - PubMed
    1. Park H.R., Moon M.J., Ahn E.H., Baek M.J., Cho H.D. Case report. Heterotopic quadruplet pregnancy: Conservative managment with ultrasonographically-guided KCl injection of cornual pregnancy and laparoscopic operation of tubal pregnancy. Fetal. Diagn. Ther. 2009;26:227–230. doi: 10.1159/000238109. - DOI - PubMed