[Management and pregnancy outcomes of heterotopic pregnancy].

Objective: To investigate the clinical features, diagnosis and treatments of heterotopic pregnancy (HP) and demonstrate the outcomes of HP after the surgical treatment of ectopic pregnancies. Methods: A retrospective analysis was performed on 144 cases of HP in Women ' s Hospital, School of Medicine, Zhejiang University from January 2003 to December 2016. Results: (1) Clinical features of HP:the average age of patients was (30.8±3.8) years old, body mass index (BMI) was (21.9±2.9) kg/m(2), and was diagnosed at (6.5±1.3) weeks gestational age. Four patients (2.8%) were naturally pregnant, 10 patients (6.9%) received ovulation induction, and 130 patients (90.3%) had received infertility treatments. Fifty-one patients (35.4%) had no clinical symptoms, and 93 patients (64.6%) had clinical symptoms included vaginal hemorrhage,abdominal pain and hemorrhagic shock caused by intraperitoneal hemorrhage. The location of ectopic pregnancy was most common in the fallopian tubes (59.0%, 85/144) and the interstitial part (33.3%,48/144) . (2) Ectopic pregnancy treatment of HP:thirteen patients underwent expectation treatment, and the remaining 131 cases underwent surgical treatment, including laparoscopy ( n= 56) , laprotomy ( n= 52) , and fetal reduction ( n= 23) . Among the 131 patients underwent surgery, intrauterine pregnancy were found inevitable abortion in 6 cases preoperatively. The total early abortion rate after surgery was 14.4% (18/125) ; the second operation rate was 3.1% (4/131) . (3) Intrauterine pregnancy outcome of HP: 120 intrauterine fetal were survival, the total live birth rate was 83.3% (120/144) .One hundred and seven intrauterine fetal were survival after operation and the live birth rate after operation was 85.6% (107/125) . Twenty-nine cases were premature delivery and the premature delivery rate was 24.2% (29/120) . There was no significant differences between tubal HP and interstitial HP group in the preterm birth rate [25.8% (16/62) vs 26.3% (10/38) ; χ(2)=0.003, P> 0.05]. Cesarean section rate of delivery in interstitial HP group was significantly higher than that in tubal HP group [97.4% (37/38) vs 59.7% (37/62) ], and the difference was statistically significant (χ(2)=17.400, P< 0.05) . Conclusions: The clinical manifestations of HP are diversified, combining of high risk factors, clinical symptoms and ultrasonography could improve the accuracy of diagnosis. Different method has been used to treat HP, such as laparoscopic or laparotomy and fetal reduction, and there are varying degrees of failure rate and postoperative abortion rate. We should consider carefully to adopt expectant management. Through individualized treatment, most HP could get good perinatal outcomes.