Live birth after laparotomy for ruptured heterotopic cornual and intrauterine twin gestation in a Spontaneous cycle: A case report and literature review

Background: Heterotopic pregnancy is the coexistence of an intrauterine and extrauterine gestation.It is a rare occurrence especially in a natural conception. Its incidence is however increasing with the advent of  assisted reproductive techniques.Case Presentation: A rare case of triplet heterotopic cornual gestation involving twin intrauterine and a cornual gestation in a spontaneous conception.She presented with an acute abdomen and she had laparotomy with cornual resection.The intrauterine pregnancy remained uneventful till term.Conclusion: Heterotopic pregnancy is a life threatening  condition.Management with laparotomy can result in the survival of the intrauterine gestation till term without adverse outcome.Keywords: Heterotopic gestation,cornual ectopic gestation,term  gestation

Contributions of uterine fibroids to infertility at Ile‑Ife, South‑Western Nigeria

Background: Uterine fibroid is the most common tumor of the female genital tract. The benign tumors often grow into large sizes and assume unsightly shapes with concomitant symptoms and signs. Being a predominantly reproductive age disease, concurrent infertility and symptomatic uterine fibroids pose management challenges. Individualization of the patient is thus essential to the success of the reproductive outcome.Objectives: This study determined the prevalence, trend, management modalities, pregnancy outcome, and exposition of factors affecting pregnancy outcome among patients presenting with uterine fibroids and infertility at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC).Materials and Methods: This is a retrospective study of case records of 106 women managed for uterine fibroids and infertility over a 5‑year period (January 1, 2012, to December 31, 2016) at the OAUTHC. The outcome measure is the pregnancy rate among those who had a myomectomy.Results: About a quarter of women with infertility had symptomatic uterine fibroids and this represents about 35%–40% of the overall number of women presenting as uterine fibroid within the study. About 84.9% had uterine size >12 weeks at presentation. Two‑third of the patients had open myomectomy alone with 43.9% achieving conception thereafter. Conception rate for myomectomy with tuboplasty was 31.3% whereas myomectomy with subsequent in vitro fertilization (IVF) was 50%. Pregnancy rate decreased with increasing size of the uterus before myomectomy.Conclusion: Symptomatic fibroid was significantly prevalent among women with infertility. Myomectomy improves fertility potential and success rate of IVF. Uterine fibroid has both direct and indirect effect on infertility and pregnancy rate in this group of the patient can be improved through routine screening for uterine fibroids and early removal of the fibroids before they grow into giants size.Keywords: Infertility; myomectomy; pregnancy outcome; uterine fibroid