Pregnancy outcomes following different surgical approaches for heterotopic interstitial and angular pregnancy.

Objective: To investigate the perioperative and pregnancy outcomes among different surgical approaches and methods for treating heterotopic pregnancy (HP) and to identify the risk factors for the loss of intrauterine pregnancy (IUP).

Methods: We retrospectively reviewed 59 cases of interstitial and angular HP treated surgically between 2014 and 2024 in two women's health centers in southwest China. Surgical methods included multi-port laparoscopy (MPL), transumbilical laparoendoscopic single-site surgery (TU-LESS), and conventional laparotomy (CL), along with cornual wedge resection and linear incision. Clinical outcomes were compared among IUP loss and successful IUP delivery; MPL, TU-LESS, and CL; and cornual wedge resection and linear incision groups. Binary logistic regression analysis was used to assess factors for predicting IUP loss.

Results: There were 47 cases of live births of IUP. The operation duration was longer in the IUP-lost group (94.58 ± 32.51 min) versus the IUP-delivered group (67.29 ± 25.37 min, P = 0.001), and the incidence of hemorrhagic shock was significantly higher in the IUP-lost group (25% vs 2.1%, P = 0.024). There was one case of incomplete uterine rupture in the cornual wedge resection group. A history of biochemical pregnancy or missed abortion (Exp B = 32.610, P = 0.042), and fresh embryo transfer (Exp B = 0.126, P = 0.022) predicts IUP loss.

Conclusion: CL, MPL, and TU-LESS, as well as cornual wedge resection and linear incision for treating HP, all showed comparable perioperative and IUP outcomes. Linear incision has relatively better surgical outcomes than cornual wedge resection. Factors such like fresh embryo transfer and a previous history of biochemical pregnancy or missed miscarriage predict IUP loss.