A case of heterotopic pregnancy resulting in intrauterine fetal death after a laparoscopic salpingectomy

We report a case of heterotopic pregnancy resulting in intrauterine fetal death (IUFD) after laparoscopic resection of an ectopic pregnancy. A 30-year-old woman, who conceived after ovulation induction with clomiphene, was referred to our hospital because of abdominal pain at 6 weeks of gestation. Ultrasound examination showed an intrauterine fetus with a heartbeat, a 3-cm right adnexal mass, and intra-abdominal hemorrhage. We diagnosed a heterotopic pregnancy with miscarriage in a right tubal pregnancy. With careful observation, the intra-abdominal hemorrhage resolved. However, we discovered an abscess in the right adnexa at 11 weeks and 1 day of gestation. Concurrently, chorioamnionitis was suspected because the patient developed purulent discharge and high fever. Antibiotics were administered, but appeared to be ineffective. Therefore, laparoscopic salpingectomy was performed at 11 weeks and 6 days of gestation. Macroscopic and microscopic examination revealed villi and abscess in the excised Fallopian tube. Subsequent to surgery, the amniotic fluid volume kept decreasing, probably because of chorioamnionitis. The fetal heartbeat disappeared at 16 weeks of gestation, and the fetus was delivered at 17 weeks. In this case, the infection of gestational products in the Fallopian tube might have been the cause of chorioamnionitis. Therefore, earlier surgery might have prevented IUFD. In the treatment of heterotopic pregnancy with a live intrauterine fetus, we tend to elect observation because of concern for the fetus. From our experience, surgery should be elected for heterotopic pregnancy in accordance with the treatment criteria for ectopic pregnancy.