“WHAT YOU SHOULD KNOW ABOUT HETEROTOPIC PREGNANCY” DANIEL M. AVERY, MD, MARION D. REED, MD, AND WILLIAM L. LENAHAN, MD (OCTOBER 2009)
Back in the days before assisted reproduction, I encountered three cases of heterotopic pregnancy in a short time, prompting the article cited below.1 As the authors mentioned, this phenomenon is still underdiagnosed—less so today than in 1961, when we did without the benefit of both ultrasonography and the ability to rapidly and accurately measure human chorionic gonadotropin (hCG) levels.
Arthur A. Fleisher II, MD
1. Fleisher AA, Seaman I. Heterotopic pregnancy: the effect of shock on the first-trimester fetus. Obstet Gynecol. 1961;18:763-766.
Dr. Avery responds: Diagnosis of heterotopic pregnancy without the benefit of technology is a real achievement
I appreciate Dr. Fleisher’s letter and mention of his paper. I had the pleasure of reading this paper from 1961 describing his series of heterotopic pregnancies. As he mentioned, these cases were diagnosed at the time of surgery and subsequent delivery in most cases without the availability of ultrasonography and quantitative hCG levels. This would be a fascinating paper for any practitioner of obstetrics and gynecology to read. We often take for granted the technological advances available to us today to make difficult diagnoses. I thank Dr. Fleisher for making this paper available to us. I will add his experience to our list of cases.