Heterotopic pregnancy with anembrionic intrauterin component

A 31 year-old woman gravida 3, para 0, abortion 2 applied to the clinic with secondary amenorrhea after ovulation induction with clomiphene citrate. Urine pregnaney test was performed and found positive. There was no history of pelvic inflammatory disease and pelvic surgical intervention. Although trans-vaginal sonographic examination revealed empty uterus, we detected an 18 mm ring-like thick-walled hyperechogenic structure within the left adnexial area which consist of fetal nod but no fetal cardiac activity, meanwhile she had a serum beta-hCG level of 198 mlU/mL Beta-hCG level was measured every 2 days. The increase of hCG levels was found more than two fold. This condition suggested the presence of intrauterine pregnaney besides extrauterine pregnancy and transvaginal ultrasonographic (TV-US) examination revealed an intrauterine gestational sac without yolk sac and embryo. That time according to the last menstrual period pregnaney was compatible with 7 w + 2 d. Control TV-US was performed 1 week later and gestational sac was demonstrated but embryo and yolk sac were invisible. Due to the prediagnosis of anembrionic pregnaney, dilatation & curettage was performed and pathologic report showed early stage placentation and decidualisation without embryo. After D&C beta-hCG level significantly decreased. Due to this decrease at beta-hCG level and the stability of the hemodynamic status and low initial beta-hCG level patient was discharged and pursued fbr beta-hCG level weekly. Follow-up examination was made till beta-hCG level decreased to the normal values. The extrauterine gestational sac under expectant management had resolved spontaneously without further medical or surgical approaching.