Uzma’s Heterotopic Pregnancy: A Rare Case

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Uzma had her last periods on 14 April, 2012. On 19 May through a strip pregnancy test she found she had conceived. She then visited a local doctor practicing privately. Relevant tests were carried out and Uzma’s pregnancy was confirmed. Everything seemed fine and Uzma was told about the expected delivery date.

Resident of Arifwala, a town of the Pakpattan district of Punjab, Uzma was in the final year of MSc when she got married. She lived with her in laws. Her husband was the eldest of five siblings and worked as a finance officer in a small private firm in Islamabad. He visited his family every two weeks.

Her in laws were expecting the first baby in the family and since it was the couple’s first baby too, the joy and excitement had no limits.

Almost two weeks after the good news, the 26 year old started having pain in the stomach. Whether sleeping or awake, eating or not her stomach used to hurt especially on the left side. Nobody at home was sure why she was in pain.

After three days she went to the same doctor. She was told her intestines had swollen. The doctor gave her medicine for a week and instructions regarding her diet. The young girl followed doctor’s directions and took the medicine for a week. The pain was reduced but did not go away completely. She then got busy preparing for her final exams. “I stopped paying attention to the pain. And kept bearing it”, says Uzma.

During the mid of June she went to her mother’s place in Wah Cantt, a small town adjacent to Taxila. She felt nausea when she got up in the morning on her third day. “I had vomiting, it was completely yellow. I also had loose motions and could not even move because of the severe pain”.

She was then taken to a gynecologist in the nearest hospital. On her way to the doctor, Uzma became unconscious and fell off the bike. She was hurt and got stitches on one of her ear. Luckily the accident did not harm her pregnancy.

She was kept in the hospital for a day. During this time she had three ultrasounds and was continuously on drips. “The doctor did not seem to identify what was wrong with me”, says Uzma. Her mother and husband had been with her the whole day. In the evening her brother came to see her after work. Frustrated to see his sister still in pain he asked the doctor what kind of treatment was being given as she was still in pain. He then approached another doctor in the same hospital and asked him to look into Uzma’s case. The other doctor after an ultrasound confirmed that Uzma had water in her stomach. He said Uzma needed a surgery and might lose the baby.

The whole family was in shock. Curious and confused as to what was happening. They still did not know why she had water in her stomach. Everyone in the family decided to take a second opinion. Her husband’s colleague referred them to Shifa International Hospital Islamabad.

She was brought to the hospital’s emergency on 19 June at midnight. After checkup she was referred to Dr Nabia Tariq, a gynecologist. Uzma was nine weeks and three days pregnant at that time. According to the doctor, Uzma was dehydrated, pale with low blood pressure (90/60mm of Hg) and pulse 100 beats per minute. Her hemoglobin level was as low as 7.75 g/dl. An ultrasound was done. Dr Nabia could see there was something wrong in the ultrasound. She consulted two of her colleagues and ws diagnosed Uzma with heterotopic pregnancy and anemia.

Dr Nabia had a meeting with Uzma’s parents and told them she had “double” pregnancy. There was a baby outside the uterus and one inside it. The one outside is a heterotopic pregnancy which is very rare. Incidence of such pregnancy is reported as 1 in 30,000.

“What happens is that one of the sacs for some reason does not find its way to the uterus and starts developing outside it. It is dangerous for both mother and the baby if not diagnosed timely”, says Dr Nabia.

Ultrasound allows a reliable and early diagnosis of heterotopic pregnancy especially a transvaginal ultrasound. “Diagnosis and management of a heterotopic pregnancy is a challenge even in the hands of a skillful gynecologist”, she adds.

Dr Nabia had given two options for the treatment. Uzma could either be treated with medicine in which case both the pregnancies would have been dissolved. But it was risky. The sac could burst inside Uzma which would be dangerous for her. The other option was to dissolve the outer pregnancy by injecting it. In this case the baby inside the uterus could be saved. Dr Nabia took Uzma’s family in confidence, told them about pros and cons of both the options.

Uzma and her family decided to go for the second option. “We did not want to lose the baby”, says Uzma. Dr Nabia carried out Uzma’s ultrasound again before proceeding. Without any further delay on the same day at 6 pm she was taken for the procedure. The whole family was standing outside the room praying for her and the baby’s health. Everybody was unsure of what was going to happen.

A 45 minute non surgical treatment was carried out. Outer gestational sac was successfully terminated. Uzma was stable at the end of the procedure. She was transfused with blood later to treat anemia.

“I was so scared before going for the treatment. It was a tough decision for me. But once the treatment ended I was at ease”, says Uzma.

She was then kept in the hospital for 24 hours under observation. The pregnancy inside the uterus was found to be healthy with normal heart activity. When Uzma went to the hospital for follow up after a week all the symptoms were gone. She had regular antenatal visits and kept taking folic acid and iron tablets for treatment of anemia. Baby grew normally throughout the pregnancy. On 9 January, 2013 a baby boy weighing 3.5 kilograms was safely delivered.

“I had been through a lot. I even fell off the motorbike and went through such complicated treatment but still I had my baby. Allah saved him at every step. He was bound to come into our lives”, says Uzma tears rolling down over her cheeks.

Mohammad Ahmed Shahid is now almost four months old. He is healthy like any other baby and a twinkle of his family.

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