TWIN TUBAL PREGNANCY: HOW TO IMPROVE THE ALGORITHM FOR RARE FORMS OF ECTOPIC PREGNANCY

Introduction. 5-8% of massive bleeding, often fatal, occurs in rare forms of ectopic pregnancy (EP). The rarest and most difficult to diagnose both at the preoperative stage, based on the use of a traditional algorithm to verify EP and during intraoperative revision, is twin tubal pregnancy (TР). Objective. Determine ways to improve the diagnostic algorithm for a rare form of EP - twin tubal pregnancy Materials and Methods. Based on two clinical cases of twin TP observed in patients in whom the final diagnosis was verified only at the postoperative histological examination stage, errors and difficulties in diagnosing this rare nosology are considered. Results. The shortcomings of the traditional diagnostic algorithm for EP, including determination of β-hCG in the blood and ultrasound of the pelvic organs in women with clinical symptoms of EP, as well as intraoperative surgical tactics in such patients, are analyzed. It is proposed to complement the diagnostic algorithm for EP with MR examination in patients with possible development of multiple pregnancy. MR symptoms of hematosalpinx (HS) in TP and HS of other etiology are described. Conclusion. Inclusion of MRI of the female pelvic organs in the algorithm of complex early diagnostics of rare forms of EP in the presence of two corpora lutea, detection of bilateral HS according to ultrasound data or implantation of two or more embryos in the IVF protocol can increase diagnostic capabilities and prevent massive blood loss in rare forms of EP.