SPONTANEOUS CONCEPTION AND INTRAUTERINE PREGNANCY IN A SYMPTOMATIC MISSED ABORTION OF ECTOPIC PREGNANCY CONCEIVED IN THE PREVIOUS CYCLE

We encountered a rare case of combined intrauterine and extrauterine p regnancy that occurred following separate spontaneous ovulations. A 33 year old woman visited our hospital with the chief complaint of abdom inal pain on April 16, 1993, Her last menstruation was from March 23 f or 6 days, However, the urinary human chorionic gonadotrophin (HCG) on April 19 was 1024 IU/l. Pelvic examination and ultrasonography indica ted an extrauterine pregnancy, which was confirmed by laparotomy and h istological identification of trophoblast cells, The urinary HCG conce ntration markedly decreased after the operation, However, the HCG leve l increased again on the fifth postoperative day, and a gestational sa c (11 mm) was identified in the uterine cavity on the 11th post-operat ive day, indicating that this intrauterine pregnancy was established f ollowing spontaneous ovulation which occurred before the removal of th e extrauterine pregnancy. This case indicates that a combined pregnanc y can occur not only after simultaneous multiple ovulations but also a fter the separate spontaneous ovulations.