{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:21:10Z","timestamp":1787757670355,"version":"build-2784847793"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Heterotopic pregnancy (HP) is the coexistence of extrauterine and intrauterine pregnancies. This case is rare, difficult to diagnose, and threatening if left untreated. Incidental rate is estimated 1 in 30,000 spontaneous pregnancies and higher in assisted reproductive techniques. HP is often missed because of the detection of intrauterine sacs; therefore, comprehensive and systematic ultrasonography (USG) is needed, especially when there is ectopic pregnancy suspicion or when there is free fluid in the pelvis. A 46-year nulligravida with 13-year primary infertility history underwent frozen embryo transfer process with positive beta-human chorionic gonadotropin 2 weeks after the procedure. Clinical pregnancy is expressed by gestational sac findings at 6-week gestation. Two weeks later, she complained of lower right abdominal pain accompanied by spots from the birth canal. USG showed intrauterine pregnancy and sac appropriate to 8-week gestation and adnexal mass accompanied by a ring of fire image. The patient underwent right salpingectomy, recovered well, and continued her pregnancy.\n                      <jats:italic toggle=\"yes\">In vitro<\/jats:italic>\n                      fertilization is the main risk factor for multiple and ectopic pregnancies. Clinical manifestations are similar to pregnancy loss or ectopic pregnancy. Specific risk factor must be acknowledged by the physician prior initial examination to rule out HP. Transvaginal ultrasound is useful in making the diagnosis of HP, especially in early pregnancy.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/gmit.gmit_92_19","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T01:08:37Z","timestamp":1639357717000},"page":"53-56","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":16,"title":["Heterotopic Pregnancy"],"prefix":"10.4103","volume":"10","author":[{"given":"Achmad Kemal","family":"Harzif","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Purnomo","family":"Hyaswicaksono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riyan Hari","family":"Kurniawan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Budi","family":"Wiweko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-11-20240830","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0015-0282(16)58378-2","article-title":"Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: A literature review from 1971 to 1993","volume":"66","author":"Tal","year":"1996","journal-title":"Fertil Steril"},{"key":"R2-11-20240830","first-page":"503","article-title":"Subchorionic hematoma associated with heterotopic pregnancy following in vitro fertilization: A case report","volume":"51","author":"Flisser","year":"2006","journal-title":"J Reprod Med"},{"key":"R3-11-20240830","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.fertnstert.2006.06.037","article-title":"A comparison of heterotopic and intrauterine-only pregnancy outcomes after assisted reproductive technologies in the United States from 1999 to 2002","volume":"87","author":"Clayton","year":"2007","journal-title":"Fertil Steril"},{"key":"R4-11-20240830","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1080\/00016340600613550","article-title":"Conservative laparoscopic treatment of heterotopic ovarian and intrauterine pregnancy following ovulation induction with gonadotropins","volume":"85","author":"Cirillo","year":"2006","journal-title":"Acta Obstet Gynecol Scand"},{"key":"R5-11-20240830","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/j.ajem.2010.07.028","article-title":"Heterotopic pregnancy resulting from in vitro fertilization","volume":"29","author":"Brunette","year":"2011","journal-title":"Am J Emerg Med"},{"key":"R6-11-20240830","first-page":"768","article-title":"Management and pregnancy outcomes of heterotopic pregnancy","volume":"53","author":"Chen","year":"2018","journal-title":"Zhonghua Fu Chan Ke Za Zhi"},{"key":"R7-11-20240830","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1002\/jcu.20715","article-title":"Sonographic appearance of heterotopic pregnancy with ruptured ectopic tubal pregnancy","volume":"38","author":"Singhal","year":"2010","journal-title":"J Clin Ultrasound"},{"key":"R8-11-20240830","doi-asserted-by":"crossref","first-page":"742","DOI":"10.3109\/01443615.2010.501414","article-title":"Heterotopic pregnancy: Tubal ectopic pregnancy with a viable IVF intrauterine pregnancy","volume":"30","author":"Melendez","year":"2010","journal-title":"J Obstet Gynaecol"},{"key":"R9-11-20240830","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.ejogrb.2014.04.046","article-title":"Management and outcome of 25 heterotopic pregnancies in Zhejiang, China","volume":"180","author":"Yu","year":"2014","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"R10-11-20240830","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.tjog.2019.11.010","article-title":"Management strategies of heterotopic pregnancy following in vitro fertilization-embryo transfer","volume":"59","author":"Lv","year":"2020","journal-title":"Taiwan J Obstet Gynecol"}],"container-title":["Gynecology and Minimally Invasive Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/GMIT.GMIT_92_19","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:49:05Z","timestamp":1787755745000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/GMIT.GMIT_92_19"}},"subtitle":["Diagnosis and Pitfall in Ultrasonography"],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.4103\/gmit.gmit_92_19","relation":{},"ISSN":["2213-3070"],"issn-type":[{"value":"2213-3070","type":"print"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}