Is expectant management feasible for select patients diagnosed with a heterotopic tubal pregnancy following in vitro fertilization/intracytoplasmic sperm injection?
Abstract Background Heterotopic pregnancy (HP) is a rare type of pathological pregnancy, and the most common site of concomitant ectopic pregnancy (EP) is the fallopian tube. Some studies have shown that expectant treatment could be considered because some EPs tend to regress spontaneously. However,...
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2024-12-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-024-07029-2 |
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| author | Yuyao Mao Yangqin Peng Mingxiang Zheng Pei Cai Fei Gong Hui Chen Ge Lin Yan Ouyang Xihong Li |
| author_facet | Yuyao Mao Yangqin Peng Mingxiang Zheng Pei Cai Fei Gong Hui Chen Ge Lin Yan Ouyang Xihong Li |
| author_sort | Yuyao Mao |
| collection | DOAJ |
| description | Abstract Background Heterotopic pregnancy (HP) is a rare type of pathological pregnancy, and the most common site of concomitant ectopic pregnancy (EP) is the fallopian tube. Some studies have shown that expectant treatment could be considered because some EPs tend to regress spontaneously. However, data on the expectant treatment of HP are lacking. This study aimed to examine the outcomes of eutopic pregnancies following expectant management of concomitant tubal EP after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Methods This was a retrospective, observational matched cohort study. All patients who conceived with tubal HP (HTP) via IVF/ICSI and were treated expectantly between January 2010 and December 2021 were enrolled. Each HTP patient managed expectantly (A) was randomly matched with one control patient who conceived with a solely eutopic pregnancy (B) and one HTP patient who underwent surgical therapy (C) from our clinical database according to predefined criteria. The expectant group and the control groups were matched for maternal age (MA; ±1 year), gravidity (0; ≥1) and gestational age (GA) at presentation (± 2 days). The pregnancy outcomes of the study group and the control groups were compared. Results More than three-quarters of the EPs in patients treated expectantly were inhomogeneous solid masses (n = 95, 76.6%), and an empty gestational sac was the second most common (n = 18, 14.5%). The rates of live birth (76.6%, 79.0%, 73.4%; P = 0.647 (A versus B); P = 0.557 (A versus C)) and early miscarriage (21.8%, 19.4%, 25.8%; P = 0.637 (A versus B); P = 0.456 (A versus C)) in the expectant group were similar to those in the eutopic group and those in the surgical group. There were no significant differences in of the preterm birth rate (7.3%, 7.3%, 7.3%; P = 1.000 (A versus B); P = 1.000 (A versus C)), perinatal mortality (1.0%, 1.0%, 1.1%; P = 1.000 (A versus B); P = 1.000 (A versus C)), GA at delivery (38.7 ± 2.1, 38.4 ± 2.4, 38.5 ± 2.3 weeks; P = 0.286 (A versus B); P = 0.425 (A versus C)) or birth weight (3294.8 ± 507.2, 3238.2 ± 646.1, 3194.5 ± 452.9 g; P = 0.498 (A versus B); P = 0.157 (A versus C)). Conclusion Expectant management was an option for select women with HTP. The prognoses of the concomitant eutopic pregnancies were comparable to those of the solely eutopic singleton pregnancies and the HTPs managed surgically. The application of this protocol in clinical practice significantly reduces the need for surgical or medical treatment of EP. Notably, close follow-up is required, and patients need to be vigilant and have immediate access to medical resources in case of an emergency. |
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| institution | DOAJ |
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| publishDate | 2024-12-01 |
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| spelling | doaj-art-9dca546739fc4a8a926834199118289f2025-08-20T02:40:18ZengBMCBMC Pregnancy and Childbirth1471-23932024-12-012411910.1186/s12884-024-07029-2Is expectant management feasible for select patients diagnosed with a heterotopic tubal pregnancy following in vitro fertilization/intracytoplasmic sperm injection?Yuyao Mao0Yangqin Peng1Mingxiang Zheng2Pei Cai3Fei Gong4Hui Chen5Ge Lin6Yan Ouyang7Xihong Li8Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive & Genetic Hospital of CITIC-XiangyaClinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive & Genetic Hospital of CITIC-XiangyaClinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive & Genetic Hospital of CITIC-XiangyaClinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive & Genetic Hospital of CITIC-XiangyaClinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive & Genetic Hospital of CITIC-XiangyaClinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive & Genetic Hospital of CITIC-XiangyaClinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive & Genetic Hospital of CITIC-XiangyaClinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive & Genetic Hospital of CITIC-XiangyaClinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive & Genetic Hospital of CITIC-XiangyaAbstract Background Heterotopic pregnancy (HP) is a rare type of pathological pregnancy, and the most common site of concomitant ectopic pregnancy (EP) is the fallopian tube. Some studies have shown that expectant treatment could be considered because some EPs tend to regress spontaneously. However, data on the expectant treatment of HP are lacking. This study aimed to examine the outcomes of eutopic pregnancies following expectant management of concomitant tubal EP after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Methods This was a retrospective, observational matched cohort study. All patients who conceived with tubal HP (HTP) via IVF/ICSI and were treated expectantly between January 2010 and December 2021 were enrolled. Each HTP patient managed expectantly (A) was randomly matched with one control patient who conceived with a solely eutopic pregnancy (B) and one HTP patient who underwent surgical therapy (C) from our clinical database according to predefined criteria. The expectant group and the control groups were matched for maternal age (MA; ±1 year), gravidity (0; ≥1) and gestational age (GA) at presentation (± 2 days). The pregnancy outcomes of the study group and the control groups were compared. Results More than three-quarters of the EPs in patients treated expectantly were inhomogeneous solid masses (n = 95, 76.6%), and an empty gestational sac was the second most common (n = 18, 14.5%). The rates of live birth (76.6%, 79.0%, 73.4%; P = 0.647 (A versus B); P = 0.557 (A versus C)) and early miscarriage (21.8%, 19.4%, 25.8%; P = 0.637 (A versus B); P = 0.456 (A versus C)) in the expectant group were similar to those in the eutopic group and those in the surgical group. There were no significant differences in of the preterm birth rate (7.3%, 7.3%, 7.3%; P = 1.000 (A versus B); P = 1.000 (A versus C)), perinatal mortality (1.0%, 1.0%, 1.1%; P = 1.000 (A versus B); P = 1.000 (A versus C)), GA at delivery (38.7 ± 2.1, 38.4 ± 2.4, 38.5 ± 2.3 weeks; P = 0.286 (A versus B); P = 0.425 (A versus C)) or birth weight (3294.8 ± 507.2, 3238.2 ± 646.1, 3194.5 ± 452.9 g; P = 0.498 (A versus B); P = 0.157 (A versus C)). Conclusion Expectant management was an option for select women with HTP. The prognoses of the concomitant eutopic pregnancies were comparable to those of the solely eutopic singleton pregnancies and the HTPs managed surgically. The application of this protocol in clinical practice significantly reduces the need for surgical or medical treatment of EP. Notably, close follow-up is required, and patients need to be vigilant and have immediate access to medical resources in case of an emergency.https://doi.org/10.1186/s12884-024-07029-2Heterotopic tubal pregnancyExpectant managementEutopic pregnancyIn vitro fertilizationIntracytoplasmic sperm injectionLive birth rate |
| spellingShingle | Yuyao Mao Yangqin Peng Mingxiang Zheng Pei Cai Fei Gong Hui Chen Ge Lin Yan Ouyang Xihong Li Is expectant management feasible for select patients diagnosed with a heterotopic tubal pregnancy following in vitro fertilization/intracytoplasmic sperm injection? BMC Pregnancy and Childbirth Heterotopic tubal pregnancy Expectant management Eutopic pregnancy In vitro fertilization Intracytoplasmic sperm injection Live birth rate |
| title | Is expectant management feasible for select patients diagnosed with a heterotopic tubal pregnancy following in vitro fertilization/intracytoplasmic sperm injection? |
| title_full | Is expectant management feasible for select patients diagnosed with a heterotopic tubal pregnancy following in vitro fertilization/intracytoplasmic sperm injection? |
| title_fullStr | Is expectant management feasible for select patients diagnosed with a heterotopic tubal pregnancy following in vitro fertilization/intracytoplasmic sperm injection? |
| title_full_unstemmed | Is expectant management feasible for select patients diagnosed with a heterotopic tubal pregnancy following in vitro fertilization/intracytoplasmic sperm injection? |
| title_short | Is expectant management feasible for select patients diagnosed with a heterotopic tubal pregnancy following in vitro fertilization/intracytoplasmic sperm injection? |
| title_sort | is expectant management feasible for select patients diagnosed with a heterotopic tubal pregnancy following in vitro fertilization intracytoplasmic sperm injection |
| topic | Heterotopic tubal pregnancy Expectant management Eutopic pregnancy In vitro fertilization Intracytoplasmic sperm injection Live birth rate |
| url | https://doi.org/10.1186/s12884-024-07029-2 |
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