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Case Reports
. 2024 Nov 14;24(1):752.
doi: 10.1186/s12884-024-06969-z.

Heterotopic pregnancy and amniotic embolism: a case report

Gabriella Soecki  1 , Elisa Carolina Hlatchuk  2 , Caroline Thereza Raymundo  2 , Ana Carolina Sater Andrade  3 , Marcela Clarissa Padeski Ferreira  3 , Ana Paula Percicote  4 , Denis José Nascimento  3 , Narcizo Leopoldo Eduardo da Cunha Sobieray  3
Affiliations
Case Reports

Heterotopic pregnancy and amniotic embolism: a case report

Gabriella Soecki et al. BMC Pregnancy Childbirth. .

Abstract

Background: Heterotopic pregnancy and amniotic embolism are rare conditions that can be challenging to diagnose. To date, there are no cases of heterotopic pregnancy associated with amniotic embolism described in the literature. Therefore, we report the case of a pancreatic heterotopic pregnancy, which led to amniotic embolism and an unfavorable maternal outcome.

Case presentation: A 20-year-old pregnant woman presented with nausea and abdominal pain refractory to drug treatment. She had an increased lipase of 205 U/L (reference 8 to 78 U/L) and a total abdominal ultrasound with biliary sludge. The pregnant woman had no known risk factors for ectopic and heterotopic pregnancy. The initial diagnostic suspicions were hyperemesis gravidarum or acute pancreatitis. During hospitalization, she fluctuated between periods of clinical improvement and worsening of abdominal pain, but serial laboratory control had a favorable and benign evolution. On the 30th day of hospitalization, the patient developed spontaneous abortion, respiratory failure, and cardiorespiratory arrest. Necropsy showed heterotopic pregnancy in the pancreatic tail, amniotic embolism, and consequent disseminated intravascular coagulation.

Conclusion: Obstetricians should suspect heterotopic pregnancy in patients with an acute abdomen. The gold standard diagnostic method for this condition is laparoscopy. In the present case, the authors consider that pancreatic pregnancy allowed the introduction of fetal antigens and amniotic fluid into the maternal bloodstream, leading to amniotic embolism and consequent disseminated intravascular coagulation.

Keywords: Amniotic fluid embolism; Case report; Ectopic pregnancy; Heterotopic pregnancy; Obstetric complication.

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Conflict of interest statement

Declarations Ethics approval and consent to participate This study was reviewed and approved by the Ethics Committee for Research on Human Beings of Clinics Hospital Complex of the University Federal of Parana, CAAE 69643523.8.0000.0096. Consent for publication Two responsible family members provided written informed consent for publication. The journal will provide documentation of the written consent upon request. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Ultrasonography of the abdomen shows the pancreas in typical topography with preserved shape, contours, dimensions, situation, and echogenicity
Fig. 2
Fig. 2
Obstetric ultrasound of a single fetus with a crown-rump length of 66 mm, present cardiac activity, and 12 weeks and six days of gestation, topical
Fig. 3
Fig. 3
MRI cholangioresonance demonstrates pancreas with preserved morphology and signal intensity with peripancreatic fat of normal appearance
See this image and copyright information in PMC

References

    1. Černiauskaitė M, Vaigauskaitė B, Ramašauskaitė D, Šilkūnas M. Spontaneous Heterotopic Pregnancy: Case Report and Literature Review. Medicina (B Aires) [Internet]. 2020 Aug 1 [cited 2023 Sep 8];56(8):1–5; 10.3390/medicina56080365 - PMC - PubMed
    1. Nguyen KP, Hudspeth M, Milestone H. Spontaneous heterotopic pregnancy: diagnosis and management. Case Rep Obstet Gynecol. 2022;2022. 10.1155/2022/2994808. - PMC - PubMed
    1. Dedhia JD, Mushambi MC. Amniotic fluid embolism. Continuing Educ Anesth Crit Care Pain. 2007;7(5):152–6. 10.1016/j.bjae.2018.05.002.
    1. Haftel A, Chowdhury YS. Amniotic Fluid Embolism. StatPearls [Internet]. 2023 Jul 3 [cited 2023 Sep 16]. https://www.ncbi.nlm.nih.gov/books/NBK559107/
    1. Maleki A, Khalid N, Rajesh Patel C, El-Mahdi E. The rising incidence of heterotopic pregnancy: current perspectives and associations with in-vitro fertilization. Eur J Obstet Gynecol Reprod Biol. 2021;266:138–44. 10.1016/j.ejogrb.2021.09.031. - PubMed

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