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Case Report
Heterotopic pregnancy and the influence of letrozole
1 Medical Student, Department of Basic Biomedical Sciences, Touro College of Osteopathic Medicine, 60 Prospect Ave, Middletown, NY 10940, USA
2 Attending Physician, Department of Obstetrics and Gynecology, Vassar Brothers Medical Center, 45 Reade Pl, Poughkeepsie, NY 12601, USA
3 Attending Physician, Department of Obstetrics, Optum Health, 2515 South Rd, Poughkeepsie, NY 12601, USA
4 Attending Physician, Department of Family Medicine, Esopus Medical PC, 120 Maple Ridge Drive, Ulster Park, NY 12487, USA
Address correspondence to:
Adele El Kareh
MD, PhD, FACOG, MS, 2507 South Road-Route 9, Poughkeepsie, NY 12601,
USA
Message to Corresponding Author
Article ID: 100126Z06LO2024
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Ocampo L, Bahrampour S, Pincinato PH, Bray A, El Kareh A, Maas AL. Heterotopic pregnancy and the influence of letrozole. Case Rep Int 2024;13(1):7–11.ABSTRACT
Introduction: Heterotopic pregnancy has become increasingly common following increased use of assisted reproductive techniques. We will examine one uncommon instance of a heterotopic pregnancy occurring in the setting of a young woman undergoing letrozole therapy for primary infertility, making it an uncommonly seen case.
Case Report: We report a young otherwise healthy female G1P0 at approximately 6 weeks gestation, who was referred from her primary care office to the Emergency Department with progressive abdominal pain that started 12 hours prior and had started to exhibit signs of hemodynamic instability. History was significant for difficulty with conception requiring letrozole treatment. Emergency laparoscopy was performed and confirmed additional ectopic pregnancy in the right fallopian tube with blood originating from the fimbriated end. Evacuation of hemoperitoneum and removal of ectopic pregnancy was completed without complication. She was discharged from the hospital in stable condition.
Conclusion: In any woman of reproductive age presenting with lower abdominal pain or abnormal bleeding, there should be a strong suspicion for a pregnancy until confirmed otherwise. These patients may benefit from prompt imaging with pelvic ultrasound to assist in earlier detection of ectopic embryo implantation and, subsequently, earlier intervention. Salpingectomy, ideally via laparoscopic approach, remains the gold standard for diagnosis and treatment of patients with a ruptured ectopic pregnancy in the setting of a heterotopic pregnancy, although surgical intervention is associated with poorer outcomes for the intrauterine pregnancy.
Keywords: Ectopic pregnancy, Heterotopic pregnancy, Letrozole, Obstetrics, Public health, Reproductive health
SUPPORTING INFORMATION
Author Contributions
Lovingly Ocampo - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sheeva Bahrampour - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Pietra Herrero Pincinato - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Adeline Bray - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Adele El Kareh - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Amelia Lisa Maas - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Lovingly Ocampo et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
