The ectopic pregnancy is treated surgically if the intrauterine pregnancy is desired. When the ectopic pregnancy is removed, the intrauterine pregnancy continues in most patients. The rate of spontaneous abortion is higher with approximately one in three ending in miscarriage (276,277). It may be possible to treat the ectopic pregnancy using nonchemotherapeutic medical treatment, such as KCl, by transvaginal or laparoscopically directed injection; however, a reported 55% may require additional surgical treatment (278).
Multiple Ectopic Pregnancies Twin or multiple ectopic gestations occur less frequently than heterotropic gestations and may appear in a variety of locations and combinations. Multiple ectopic pregnancies are thought to be rare, but with the advent of assisted reproductive technologies the incidence appears to be rising. A recent review of bilateral tubal pregnancies reported 242 cases between 1918 and 2007, with 42 cases in the past 10 years alone. Fifty percent of these twin tubal pregnancies were associated with assisted reproductive technologies (279). Another review of 163 cases of tubal ectopic pregnancies had a reported rate of twin tubal pregnancies of 2.4% (280). Although most reports are confined to twin tubal gestations, ovarian, interstitial, and abdominal twin pregnancies were reported. Twin and triplet gestations were reported following partial salpingectomy and IVF (281,282). Management is similar to that of other types of ectopic pregnancy and is somewhat dependent on the location of the pregnancy.
Pregnancy after Hysterectomy The most unusual form of ectopic pregnancy is one that occurs after vaginal or abdominal hysterectomy (283,284). Such a pregnancy may occur after supracervical hysterectomy because the patient has a cervical canal that may provide intraperitoneal access. Pregnancy may occur in the perioperative period with implantation of the already fertilized ovum in the fallopian tube. Pregnancy after total hysterectomy probably occurs secondary to a vaginal mucosal defect that allows sperm into the abdominal cavity.
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