RESUMO
OBJECTIVE: To describe an effective two-step surgical approach for the management of cesarean scar ectopic pregnancies (CSEPs). CSEPs occur at an estimated frequency of 1 in 1,800 pregnancies, constituting approximately 6% of ectopic pregnancies in women with a history of prior cesarean delivery [1, 2]. Despite numerous recommended therapeutic approaches, the most effective treatment strategy remains uncertain [3]. DESIGN: We present an innovative double-step technique for the management of a patient with a CSEP involving hysteroscopic subchorionic injection of methotrexate (MTX), followed by laparoscopic resection of the residual gestational sac and simultaneous repair of the uterine defect. SETTING: Academic tertiary hospital. PATIENT: A 34-year-old G2P1001 with a history of prior cesarean section presented at 10 weeks of gestation. Ultrasound revealed a gestational sac within the niche of the previous cesarean scar, confirming the diagnosis of a CSEP. The patient included in this video gave consent for publication of the video and posting of the video online, including on social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, and Scopus, among others), and other applicable sites. INTERVENTION: The initial treatment involved hysteroscopic administration of MTX within the placental intervillous spaces, ensuring precise medication delivery. The administered dose of MTX was 1 mg/kg. Following the normalization of beta-human chorionic gonadotrophin (ß-hCG) levels, laparoscopic resection of the remaining gestational sac and reconstruction of the uterine wall defect were performed. MAIN OUTCOME MEASURES: We have implemented a management strategy focusing on ectopic pregnancy removal and addressing defect revision. The hysteroscopic approach allows for a clear assessment of the ectopic pregnancy and facilitates precise MTX administration, enhancing its effectiveness by increasing drug concentration within the placental intervillous space. Delaying surgical repair until after the ß-hCG levels have decreased reduces the risk of excessive bleeding during the procedure, as lower ß-hCG levels are associated with reduced vascularity at the ectopic site. Subsequent laparoscopic resection allows for complete removal of the remaining products of conception and repair of the defect, preserving the uterus and restoring normal anatomy. Compared to other surgical approaches, our two-step approach enables a more precise evaluation of placental implantation, making it a highly effective surgical method. RESULTS: We successfully managed a CSEP using a double-step technique. This involved hysteroscopic injection of subchorionic MTX, followed by laparoscopic resection of the residual gestational sac. Concurrently, we repaired the uterine defect. Both procedures were performed in an outpatient setting without complications detected during or after treatment. At the follow-up visit, the patient reported good health, and subsequent ultrasound confirmed an empty isthmocele. CONCLUSION: This sequential hysteroscopic and laparoscopic approach represents a definitive and effective minimally invasive surgical option for the treatment of CSEP.
Assuntos
Abortivos não Esteroides , Cesárea , Cicatriz , Histeroscopia , Laparoscopia , Metotrexato , Gravidez Ectópica , Humanos , Feminino , Metotrexato/administração & dosagem , Gravidez , Gravidez Ectópica/cirurgia , Gravidez Ectópica/etiologia , Gravidez Ectópica/tratamento farmacológico , Gravidez Ectópica/diagnóstico , Histeroscopia/métodos , Cicatriz/etiologia , Cicatriz/cirurgia , Adulto , Cesárea/efeitos adversos , Abortivos não Esteroides/administração & dosagem , Laparoscopia/efeitos adversos , Saco Gestacional/cirurgia , Resultado do TratamentoRESUMO
Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)
Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)
Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)
Assuntos
Humanos , Feminino , Gravidez , Cuidado Pré-Natal , Gravidez de Alto Risco , Intervenção Psicossocial , Cardiopatias Congênitas , Ansiedade , Orientação , Dor , Relações Pais-Filho , Pais , Paternidade , Equipe de Assistência ao Paciente , Pacientes , Pediatria , Placenta , Placentação , Complicações na Gravidez , Manutenção da Gravidez , Prognóstico , Teoria Psicanalítica , Psicologia , Transtornos Puerperais , Qualidade de Vida , Radiação , Religião , Reprodução , Fenômenos Fisiológicos Reprodutivos e Urinários , Cirurgia Geral , Síndrome , Anormalidades Congênitas , Temperança , Terapêutica , Sistema Urogenital , Bioética , Consultórios Médicos , Recém-Nascido Prematuro , Trabalho de Parto , Gravidez , Prenhez , Resultado da Gravidez , Adaptação Psicológica , Preparações Farmacêuticas , Ecocardiografia , Espectroscopia de Ressonância Magnética , Família , Aborto Espontâneo , Educação Infantil , Proteção da Criança , Saúde Mental , Saúde da Família , Taxa de Sobrevida , Expectativa de Vida , Causas de Morte , Ultrassonografia Pré-Natal , Mapeamento Cromossômico , Licença Parental , Competência Mental , Rim Policístico Autossômico Recessivo , Síndrome de Down , Assistência Perinatal , Assistência Integral à Saúde , Compostos Químicos , Depressão Pós-Parto , Manifestações Neurocomportamentais , Crianças com Deficiência , Técnicas e Procedimentos Diagnósticos , Número de Gestações , Intervenção em Crise , Afeto , Análise Citogenética , Espiritualidade , Cumplicidade , Valor da Vida , Parto Humanizado , Morte , Tomada de Decisões , Mecanismos de Defesa , Ameaça de Aborto , Atenção à Saúde , Demência , Incerteza , Organogênese , Pesquisa Qualitativa , Gestantes , Diagnóstico Precoce , Nascimento Prematuro , Medição da Translucência Nucal , Mortalidade da Criança , Depressão , Transtorno Depressivo , Período Pós-Parto , Diagnóstico , Técnicas de Diagnóstico Obstétrico e Ginecológico , Etanol , Ego , Emoções , Empatia , Meio Ambiente , Humanização da Assistência , Acolhimento , Ética Profissional , Forma do Núcleo Celular , Nutrição da Gestante , Medida do Comprimento Cervical , Conflito Familiar , Terapia Familiar , Resiliência Psicológica , Fenômenos Reprodutivos Fisiológicos , Doenças Urogenitais Femininas e Complicações na Gravidez , Saco Gestacional , Evento Inexplicável Breve Resolvido , Morte Fetal , Desenvolvimento Embrionário e Fetal , Imagem Multimodal , Mortalidade Prematura , Tomada de Decisão Clínica , Medicina de Emergência Pediátrica , Criança Acolhida , Liberdade , Esgotamento Psicológico , Entorno do Parto , Frustração , Tristeza , Respeito , Angústia Psicológica , Genética , Bem-Estar Psicológico , Obstetra , Culpa , Felicidade , Ocupações em Saúde , Hospitalização , Maternidades , Hospitais Universitários , Desenvolvimento Humano , Direitos Humanos , Imaginação , Infecções , Infertilidade , Anencefalia , Jurisprudência , Complicações do Trabalho de Parto , Licenciamento , Acontecimentos que Mudam a Vida , Cuidados para Prolongar a Vida , Solidão , Amor , Corpo Clínico Hospitalar , Deficiência Intelectual , Princípios Morais , Mães , Narcisismo , Doenças e Anormalidades Congênitas, Hereditárias e Neonatais , Neonatologia , Malformações do Sistema Nervoso , Apego ao ObjetoRESUMO
RESUMEN Introducción: El embarazo ectópico en cicatriz de cesárea previa es una forma novedosa y potencialmente mortal de implantación anormal de un saco gestacional dentro del miometrio y el tejido fibroso de la cicatriz. Se desconoce la historia natural de esta condición para lo cual no existe consenso en su manejo. Presentación de caso: Se presenta un caso que se manejó quirúrgicamente de forma conservadora por minilaparotomía, evacuación del tejido trofoblástico, lográndose preservar el útero. Con edad gestacional de 10 semanas, se aplicó metrotexate localmente e intramuscular. La paciente evolucionó satisfactoriamente hacia la mejoría siendo dada de alta. Métodos: Se realiza una revisión bibliográfica en bases de datos Pub Med y Science Direct con las palabras claves obtenidas del MeSH: "Scar ectopic pregnancy" durante los años 2000 y 2018. Se presentan las alternativas de manejo, tanto médico como quirúrgico, sin embargo, ello estará sujeto a las condiciones de la paciente y a la experiencia del médico tratante(AU)
ABSTRACT Introduction: Ectopic pregnancy in a previous caesarean section is a novel and life-threatening form of abnormal implantation of a gestational sac within the myometrium and the fibrous tissue of the scar. The natural history of this condition is unknown, thus there is no consensus in its management. Case report: We report a case that was surgically managed in conservative way by minilaparotomy, trophoblastic tissue evacuation. The uterus was preserved. The gestational age was 10 weeks. Metrotexate was applied locally and intramuscularly. The patient evolved satisfactorily towards improvement and discharge. Methods: A literature review during the years 2000 and 2018 was carried out in Pub Med and Science Direct databases. The keywords from MeSH used were "Scar ectopic pregnancy". Both medical and surgical management alternatives are presented, however the patient condition and the experience of the attending physician will contribute as well(AU)
Assuntos
Humanos , Feminino , Adulto , Gravidez Ectópica/diagnóstico , Saco Gestacional/patologia , Laparotomia/métodos , Miométrio , Literatura de Revisão como Assunto , Bases de Dados BibliográficasRESUMO
RESUMEN La protuberancia coriónica (del inglés chorionic bump) es una condición que involucra al saco gestacional y que puede ser visualizada en la ecografía de primer trimestre. Ha sido descrita como una convexidad irregular que protruye hacia el saco gestacional y que probablemente corresponda a la formación de un hematoma en la superficie coriodecidual. Nosotros reportamos los hallazgos y el seguimiento ecográfico de un caso, junto con una revisión de la literatura.
SUMMARY Chorionic bump is a condition that involves the gestational sac and can be viewed during the first-trimester ultrasound scan. It has been described as an irregular convexity protruding into the gestational sac and probably corresponds to the formation of a hematoma within the choriodecidual surface. We reported both the sonographic findings and follow-up of a case, along with a review of the literature.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Primeiro Trimestre da Gravidez , Resultado da Gravidez , Ultrassonografia Pré-Natal , Saco Gestacional/diagnóstico por imagem , Córion/diagnóstico por imagem , Ultrassonografia DopplerRESUMO
Background: Ectopic pregnancy mainly refers to tubal pregnancy and abdominal pregnancy. Tubal pregnancy presents as an implanted embryo that develops in the fallopian tubes, and is relatively common in humans. In animals, tubal pregnancy occurs primarily in primates, for example monkeys. The probability of a tubal pregnancy in non-primate animals is extremely low. Abdominal pregnancy is a type of ectopic pregnancy that occurs outside of the uterus, fallopian tube, ovary, and ligament (broad ligament, ovarian ligament, suspensory ligament).This paper describes two cases of ectopic pregnancy in cats.Cases: Cat 1. The presenting sign was a significant increase in abdominal circumference. The age and immune and sterilization status of the cat were unknown. On palpation, a 4 cm, rough, oval-shaped, hard mass was found in the posterior abdomen. Radiographic examination showed three high-density images in the posterior abdomen. The fetus was significantly calcified and some feces was evident in the colon. The condition was preliminarily diagnosed as ectopic pregnancy. Cat 2. The owner of a 2-year-old British shorthair cat visited us because of a hard lump in the cats abdomen. The cat had a normal diet and was drinking normally. Routine immunization and insect repulsion had been implemented. The cat had naturally delivered five healthy kittens two months previous. Radiographs showed an oval-shaped mass with a clear edge in the middle abdominal cavity. Other examinations were normal. The case was preliminarily diagnosed as ectopic pregnancy, and the pregnancy was surgically terminated. The ectopic pregnancies were surgically terminated. During surgery, the structures of the uterus and ovary of cat 1 were found to be intact and the organs were in a normal physiological position. Cat 1 was diagnosed with primary abdominal pregnancy. In cat 2, the uterus left side was small and the fallopian tube on the same side was both enlarged and longer than normal.[...](AU)
Assuntos
Animais , Feminino , Gravidez , Gatos , Gravidez Ectópica/veterinária , Gravidez Abdominal/veterinária , Gravidez Tubária/veterinária , Tubas Uterinas , Saco GestacionalRESUMO
Background: Ectopic pregnancy mainly refers to tubal pregnancy and abdominal pregnancy. Tubal pregnancy presents as an implanted embryo that develops in the fallopian tubes, and is relatively common in humans. In animals, tubal pregnancy occurs primarily in primates, for example monkeys. The probability of a tubal pregnancy in non-primate animals is extremely low. Abdominal pregnancy is a type of ectopic pregnancy that occurs outside of the uterus, fallopian tube, ovary, and ligament (broad ligament, ovarian ligament, suspensory ligament).This paper describes two cases of ectopic pregnancy in cats.Cases: Cat 1. The presenting sign was a significant increase in abdominal circumference. The age and immune and sterilization status of the cat were unknown. On palpation, a 4 cm, rough, oval-shaped, hard mass was found in the posterior abdomen. Radiographic examination showed three high-density images in the posterior abdomen. The fetus was significantly calcified and some feces was evident in the colon. The condition was preliminarily diagnosed as ectopic pregnancy. Cat 2. The owner of a 2-year-old British shorthair cat visited us because of a hard lump in the cats abdomen. The cat had a normal diet and was drinking normally. Routine immunization and insect repulsion had been implemented. The cat had naturally delivered five healthy kittens two months previous. Radiographs showed an oval-shaped mass with a clear edge in the middle abdominal cavity. Other examinations were normal. The case was preliminarily diagnosed as ectopic pregnancy, and the pregnancy was surgically terminated. The ectopic pregnancies were surgically terminated. During surgery, the structures of the uterus and ovary of cat 1 were found to be intact and the organs were in a normal physiological position. Cat 1 was diagnosed with primary abdominal pregnancy. In cat 2, the uterus left side was small and the fallopian tube on the same side was both enlarged and longer than normal.[...]
Assuntos
Feminino , Animais , Gravidez , Gatos , Gravidez Abdominal/veterinária , Gravidez Ectópica/veterinária , Gravidez Tubária/veterinária , Saco Gestacional , Tubas UterinasRESUMO
Ultrasonography has been used to diagnose and monitor pregnancy. However, in the queen, most of ultrasonographic and endocrinological studies have been performed using small number of observations during limited periods of pregnancy. The aim of this study was to derive equations to predict the gestation age and parturition time using ultrasonographic embryo fetus measurements and serum progesterone (P4) concentration measurements. Mixed-breed queens (n = 16), aged between 24 and 36 months and weighing between 2 and 4 kg, were daily monitored by ultrasonography since 21 days after the first mating to parturition. Gestational sac (GS) was measured from longitudinal (length [LEN], anterior-posterior [ATP]) and transverse images (width [WID]), GS volume was calculated by the prolate ellipse formula, and GS diameter was calculated by orthogonal measurements. Fetal measurements included crown-rump length (CRL), head diameter (HD), and body diameter (BD). Gestational sac, fetal measurements, and serum P4 concentration were recorded and analyzed by ANOVA. Correlation and linear regression analyses were performed and equations were derived to estimate predicted values and 95% confidence interval for GS parameters and P4 concentrations from 21 to 63 days after the first mating and to estimate predicted values and 95% confidence interval for fetal parameters from Day 35 to 63 of gestation. The average concentrations of serum P4 concentration from Day 22 to 47 of gestation remained between 32.27 ± 4.25 and 16.25 ± 2.45 ng/mL. After that, a gradual decline occurs reaching a concentration of 2.99 ± 1.29 ng/mL 1 day before parturition. A positive and significant correlation between the ultrasonographic measurements (LEN, ATP, WID, GS volume and diameter, uterine wall thickness, CRL, HD, and BD) with number of days after the first mating was observed (P < 0.001). We observed a positive and significant correlation between GS measurements (LEN, ATP, and WID) and between fetal measurements (CRL, HD, and BD) and a negative and significant correlation between serum P4 concentration with GS (LEN, ATP, and WID), uterine wall thickness, and fetal (CRL, HD, and BD) measurements. In addition, there was a positive and significant correlation between serum P4 concentrations with days after the first mating to parturition. In conclusion, the equations derived from this study will be useful for pregnancy monitoring and for estimating pregnancy age in queens from Day 21 until parturition for animals with similar weight and age.
Assuntos
Gatos/fisiologia , Idade Gestacional , Progesterona/sangue , Ultrassonografia Pré-Natal/veterinária , Animais , Cruzamento , Estatura Cabeça-Cóccix , Feminino , Saco Gestacional/diagnóstico por imagem , Parto/fisiologia , Gravidez , Útero/anatomia & histologiaRESUMO
Background: The very first sign to confirm pregnancy in bitches is the gestacional sac detection. In this primary moment, it is very small with only few millimeters. The average time for gestational sacs visualization is approximately 20 days after mating (2 mm) surrounded by a thin hyperechoic wall (trophoblasts). The Doppler is a new method for pregnancy diagnosis in bitches. The measurement of velocity peak and vascular resistance index of the corpus luteum are used for such purpose. The precocity on detection pregnancy in bitches is an important tool for differential diagnosis between physiologic uterine alterations and uterine diseases. The aim of the current study was to assess the effi ciency of the B-mode and Triplex Doppler ultrasound for early-stage pregnancy diagnosis in Shi-Tzu bitches, using ecobiometry of the gestational sac and corpus luteum vascular index. Materials, Methods & Results: Ten healthy Shi-Tzu bitches were evaluated. Pregnancy diagnosis was carried out using the B-mode. The ecobiometry of the gestational sac were characterized by the variables the outer (OLL) and inner (ILL) latero-lateral diameters, and the outer (ODV) and inner (IDV) dorso-ventral diameters. The corpus luteum vascularization was studied by the sistolic velocity peak (PVS), end-diastolic velocity (EDV), vascular resistance (RI) and pulsativity indexes (PI) using the Triplex Doppler. The ultrasound pregnancy diagnosis was carried out on days 14.2 ± 2.04 post mating. The earliest pregnancy diagnosis occurred on day 12. Positive correlation on linear regression was observed between ILL and IDV and the date of the pregnancy diagnosis (r2 = 0.7 and P = 0.0027; r2 = 0.7 e P = 0.0025, respectively). On corpus luteum Triplex Doopler assessment, PVS was 11.67 ± 2.53 cm/s, EDV was 5.52 ± 1.6 cm/s, PI was 1.04 ± 0.45 and RI was 0.61 ± 0.1. Discussion: Early diagnosis observed in the present study for canine pregnancy is an important differential in veterinary obstetrics. Gestational sac was detected in the uterine horn on the 20th day post LH peak, 18 days following ovulation in a Beagle bitch and the ultrasound diagnosis of pregnancy was performed 18-24 days following the fi rst and last mating, respectively, in Yorkshire dogs. Those results highlighted the difference between the dates for early-stage pregnancy diagnosis among different canine breeds. The precocity for the ultrasound pregnancy diagnosis depends on the visualization of the gestational sac, which is directly related to embryogenesis. The assessment of the ecobiometry of the gestational sacs may aid on the early-stage ultrasound pregnancy diagnosis in bitches. The values of corpus luteum vascular index in Shi-Tzu bitches in the current study were different from those found in other trial in bitches and in women. Such values may be justifi ed by the differences on the corpus luteum structures between the canine and human species. Regarding to Triplex Doppler in pregnant bitches, the values of PI and EDV could be determined, which hadn't been reported before in veterinary medicine for the study of corpus luteum blood flow. In conclusion, the detection of pregnancy on early-stage using ultrasound examination is feasible in Shi-Tzu bitches, by the 12th day post conception. It was also possible to determinate important ecobiometry values of the gestacional sac and corpus luteum vascular index using Triplex Doppler.
Assuntos
Animais , Feminino , Gravidez , Cães , Prenhez , Ultrassonografia Doppler/veterinária , Corpo Lúteo/diagnóstico por imagem , Saco Gestacional/diagnóstico por imagemRESUMO
Thirty-one pregnant agoutis, between Days 9 and 103 of gestation (Day 1 = day of detection of sperm in the vaginal smear), underwent B-mode ultrasonography; gestational sac diameter (GSD), crown-rump length (CRL), embryonic-fetal diameter (EFD), and placenta diameter (PD) were measured. There were positive correlations (P < 0.05) between GSD and CRL (r = 0.98), GSD and PD (r = 0.88), CRL and PD (r = 0.86), days of gestation (DG) and CRL (r = 0.85), and DG and PD (r = 0.73). The gestational sac was first observed on Day 14. The embryo was first seen on Day 18 in 9/31 of pregnant agoutis and on Day 22 in 20/31 of pregnant agoutis. Heartbeats were detected from the Day 25 and placentas were observed in 100% of the animals from Day 25. Early limb bud and ossification of the fetal skull were identified on Days 27 (15/31) and 45 (24/31), respectively. Fetal orientation (head and body) was evident from Day 40, the stomach, liver and lungs were identified on Day 50, the kidneys were reliably seen only on Day 55, and the aorta and vena cava were seen on Day 70. The fetal bowel and the urinary bladder were the last structures to be observed (Day 85). Ultrasonography was effective for early pregnancy diagnosis in agouti and for obtaining information on embryonic and fetal structures that could be used to predict gestational age and birth, thereby contributing to their reproductive management in captivity.
Assuntos
Desenvolvimento Embrionário , Desenvolvimento Fetal , Idade Gestacional , Roedores/embriologia , Ultrassonografia Pré-Natal/veterinária , Animais , Estatura Cabeça-Cóccix , Feminino , Feto/embriologia , Saco Gestacional/anatomia & histologia , Saco Gestacional/diagnóstico por imagem , Modelos Lineares , Organogênese , Placenta/diagnóstico por imagem , GravidezRESUMO
PURPOSE: To describe a unique case of MZ dichorionic twins and MZ monochorionic triplets in a quintuplet gestation after intracytoplasmatic sperm injection (ICSI) and blastocyst transfer. METHODS: Case report. A 24-year-old woman underwent ICSI and received two blastocysts transferred. A quintuplet gestation was established .Transvaginal ultrasonography was performed sequentially during early pregnancy. RESULTS: Three intrauterine gestational sacs were revealed at about 5th week. At the 7th week, five gestational sacs presenting heart beats were detected and a quintuplet pregnancy consisting of two monozygotic (MZ) dichorionic twins and three MZ monochorionic triplets was determined. At the 10th week, a single gestational sac with heart beats was detected. The prenatal course was uneventful. A healthy baby was born at 36th week. CONCLUSION: Few other reports have described the occurrence of a quintuplet gestation after the transfer of two blastocysts generated by ICSI. Our case is unique in that the two blastocysts underwent two different splitting processes, which occurred possibly at a similar time giving rise to MZ dichorionic twins and MZ monochorionic triplets.