Abstract:Objective To investigate the clinical features, diagnosis, treatment of combined intrauterine and extrauterine pregnancies (heterotopic pregnancies, HP) and the influence of surgery management on intrauterine pregnancy outcome. Methods A retrospective study was conducted in 47 patients with HP diagnosed by operation in Shanghai Red House Obstetrics and Gynecology Hospital between January 2005 and January 2012. Out of 47 patients, 4 were nature conception, and 43 were conception following in vitro fertilization and embryo transfer (IVF-ET). Results The patients were 20 to 46 years old (median age was 31 years). The implantation sites of ectopic pregnancy were cornua uteri (5 cases) and fallopian tubes (42 cases) including stump of fallopian tube(2 cases), interstitial part(8 cases), isthmus (1 case) and ampulla (31 cases). Intraperitoneal bleeding greater than 500 ml was found in four cases (3 cases were after IVF-ET, and 1 case was nature conception). The rupture of ectopic pregnancy lesions was found in seven cases (2 cases were nature conception, and 5 cases were after IVF-ET). Ultrasound findings prompted that there were pregnancy sac, fetal bud and fetal heart in adnexal mass in 23 HP patients, thus the preoperative diagnosis rate was 49% (23/47). All patients underwent surgical treatment for ectopic pregnancy in whom 3 underwent laparotomy surgery and 44 underwent laparoscopic surgery. Thirty-nine patients with fertility requirements received tocolysis treatment after ectopic pregnancy operation, and their intrauterine pregnancy outcome were followed up. Out of 39 patients, 2 case received laparotomy(1 case of full-term delivery, 1 case of abortion ), and 37 cases received laparoscopic surgery had a 76% (28/37) success rate of intrauterine pregnancy (27 cases of full-term birth, 1 case of premature delivery with twins, 9 cases of abortion). There were 9 cases of cornual pregnancy-interstitial tubal pregnancy with 66% (6/9) success rate of intrauterine pregnancy (6 cases of full-term birth, 3 cases of abortion). There were 30 cases of ampulla- stump of fallopian tube pregnancy with 83% (25/30) success rate of intrauterine pregnancy (24 cases of full-term birth, 1 case of premature delivery with twins, 5 cases of abortion). Conclusions Ectopic pregnancy site for HP was most located in the ampulla of fallopian tube. Ultrasound is essential for the diagnosis of HP. Laparoscopic surgery is a rapid and accurate method of clarifying diagnosis and removing ectopic pregnancy lesions. The factors such as operation method, operation time, intraoperative blood loss, with or without rupture of the ectopic focus, ectopic pregnancy site and intraperitoneal bleeding volume do not affect the intrauterine pregnancy outcome.