PMC4930808_01
Patient number 1. Pelvic ultrasound showing the intrauterine and extrauterine/tubal ectopic pregnancies, both with fetal pole (FP), fetal heart rates (+FHM) present, and free fluid (FF) in the peritoneal cavity.
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Pelvic ultrasound (Figure 1) revealed a single live intrauterine pregnancy of 8 weeks and 4 days with a fetal heart rate of 188 beats per minute (BPM) and an ectopic pregnancy was seen in the right adnexa of 8 weeks and 0 days with a fetal heart rate of 183 bpm.
Patient number 1. Operative finding showing a ruptured right ectopic pregnancy (black arrow) with an ovarian corpus luteal cyst (blue arrow).
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An exploratory laparotomy was performed revealing an approximately 5 cm x 3 cm ruptured ectopic pregnancy at the ampulla of the right fallopian tube, as well as an intact ovarian corpus luteal cyst (Figure 2).
PMC4930808_02
Patient number 2. Obstetric ultrasound on 3/2/2014: intrauterine gestational sac seen. There is adjacent heterogeneity suggesting subchorionic hemorrhage. No fetal cardiac activity detected. Fetal pole measures approximately 2.9 mm.
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Pathology for patient 2. Specimen 1: endometrium and product of conception (POC) from D&E for VTOP. Green circles: decidua and chorionic villi with viable syncytiotrophoblast; blue circles (purple color): degenerating villi; red circles (pink color): fibrin or degenerated villi.
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Moderate amount of product of conception (POC) was collected during D&C, which pathologic examination showed to be decidua and chronic villi (Figure 4).
Pathology for patient 2. Specimen 2: left tubal ectopic pregnancy from laparoscopy. Tubal pregnancy: slide from fallopian tube, showing the wall of fallopian tube and a tubal pregnancy with decidua, chorionic villi, and syncytiotrophoblast inside the fallopian tube, confirming the ectopic pregnancy in the fallopian tube and therefore heterotopic pregnancy.
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Laparoscopic excision of left corneal ectopic pregnancy with mini-laparotomy for specimen retrieval was done and an approximately 4 cm x 4 cm left corneal ectopic pregnancy was excised, which was also sent to pathology, and pathologic examination showed decidua and chronic villi (Figure 5) and therefore diagnosis of heterotopic pregnancy was confirmed.