Management of a Heterotopic Pregnancy at the University Clinics of Kinshasa: A Case of a Triple Pregnancy; Removal of the Ectopic Pregnancy and Progression of the Intrauterine Twin Pregnancy

Heterotopic pregnancy is the coexistence of an intrauterine pregnancy and an extrauterine pregnancy, regardless of its location. It is an extremely rare condition, with an estimated prevalence of between 1 in 10,000 and 1 in 30,000 worldwide. Literature data show an increasing frequency of heterotopic pregnancies, becoming more common with the rise in medically assisted reproduction. According to U.S. data from ART (Assisted Reproduction Techniques), there were 485 heterotopic pregnancies out of 553,000 pregnancies conceived between 2001 and 2011, with the risk estimated at 1 in 1100 pregnancies, compared to 1 in 30,000 pregnancies for a spontaneous pregnancy. Its incidence is significant at an advanced age due to the higher likelihood of past gynecological infections and the rise in assisted reproductive technology (ART). The diagnosis remains difficult due to its confusing symptomatology. Diagnosis is often made with pelvic ultrasound, usually in the first trimester of pregnancy. Laparoscopy not only confirms the diagnosis but also allows for appropriate management today. The management of heterotopic pregnancies aims to remove the extrauterine pregnancy while preserving the intrauterine pregnancy as much as possible and limiting the risk of recurrence. Heterotopic pregnancy has implications for the maternal and fetal prognosis.