Diagnosis and management of heterotopic pregnancy following embryo transfer: clinical analysis of 55 cases from a single institution

The aims of this study were to summarize the clinical features of patients with heterotopic pregnancy (HP) following embryo transfer (ET) and explore the risk factors for miscarriage after surgery.

All patients with HP following ET treated by surgery between August 2014 and August 2015 in Chongqing Health Center for Women and Children were retrospectively reviewed.

Fifty-five patients were identified, including 40 with tubal HP, 9 interstitial HP and 6 cornual HP. The most frequent manifestations before diagnosis was abdominal pain (29.1%), while 19 patients (34.5%) had no symptoms before diagnosis. The sensitivity of symptoms for HP was 65.5%. Gestational age at symptom onset of these patients with symptoms (n = 36) was 5.8 weeks (range 4.7–8.1). Forty-seven patients (85.5%) were suspected of HP when they received first transvaginal ultrasonography (TVS). The mean gestational age at diagnosis was 6.3 weeks (range 4.7–8.3, 16–41 days after ET). First TVS suggesting HP (P = 0.000) and first TVS performed before day 27 (P = 0.000) were two independent predictors for gestational age at diagnosis. Gestational age at surgery day was 6.7 weeks (range 5.3–10.7). Fifty-one patients (92.7%) resulted in a live birth. Gestational age at surgery day was the only independent risk factor for miscarriage in patients with HP treated by laparotomy (OR 0.003, 95% CI 0.001–0.604).

Routine TVS at day 27 after ET could facilitate the diagnosis of HP, symptoms onset before or after day 27 are clues to early diagnosis. Prompt surgery after diagnosis may improve the prognosis of HP following ET.