Adnexal Mass in Pregnancy Diagnosed as Heterotopic Pregnancy A Case Report

Backgrounds: Adnexal masses have the prevalence of around 0.19 - 8.8% in pregnancy. The incidence decreases with increasing gestational age.Heterotopic pregnancy is a rare and potentially dangerous condition occurring in only 1 in 30,000 spontaneous pregnancies. With the advent of Assisted Reproduction Techniques (ART) and ovulation induction, the overall incidence of heterotopic pregnancy has risen to approximately 1 in 3,900 pregnancies. However, obstetricians and emergency medicine physicians should be considered this entity as a differential diagnosis in the pregnancy and simultaneously adnexal mass. Material and Method : A 29-year-old pregnant woman gravida3 para1 abort1 with gestatinal age of 10 week referred to obstetric clinic with sonography consistent with left adnexal mass. She had severe abdominal pain in left lower quadrant. Sonography of abdomen and pelvis showed a heteroechoic lesion measured 70 x50 mm adhered to ovary in left adnex suspicious to hemorrhagic cyst and a single live embryo in uterine cavity. In her past history ,she had secondary infertility for 1 yr. Following 2 courses of clomiphene citrate, she has been pregnant. She was observed and her pain recovered ,so she was discharged after 2 days.Four weeks next, sonography was done. There was a multiseptate cyst in left ovary measured 95x80 mm. Due to increasing size, she underwent laparoscopy in gestational age of 14 wk. There was a mass in posterior cul de sac adhered to left adnex and some old clot and adhesion around it. The mass was removed and sent for histologic evaluation.The pathology confirmed an ectopic pregnancy. In follow up, there was no problem in prenatal care. At gestational age 39 week, she delivered a healty male baby weighing 3230g via cesarean section due to previous c/s .Result: Nowaday, laparoscopy is a reasonable approach for management of adnexal masses in pregnancy. Compare with laparotomy, there was shorter hospital stay, fewer postoperative complications, decreased blood loss.About pregnancy outcomes, there was no differences between two procedures.Conclusion: We should think about heterotopic pregnancy even in low risk patients as differential diagnosis in adnexal masses in pregnancy and when there is risk factor for heterotopic pregnancy especially when the patient has abdominal pain