<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0300-9041</journal-id>
<journal-title><![CDATA[Ginecología y obstetricia de México]]></journal-title>
<abbrev-journal-title><![CDATA[Ginecol. obstet. Méx.]]></abbrev-journal-title>
<issn>0300-9041</issn>
<publisher>
<publisher-name><![CDATA[Federación Mexicana de Colegios de Obstetricia y Ginecología A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0300-90412018000900611</article-id>
<article-id pub-id-type="doi">10.24245/gom.v86i9.2269</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Embarazo heterotópico espontáneo con ruptura tubárica y choque hipovolémico. Reporte de un caso y revisión de la bibliografía]]></article-title>
<article-title xml:lang="en"><![CDATA[Spontaneous heterotopic pregnancy with tubular breakage and hypovolemic Shok. A case report and literature review]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Benavides-Calvache]]></surname>
<given-names><![CDATA[Juan Pablo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Escobar-Vidarte]]></surname>
<given-names><![CDATA[María Fernanda]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hurtado-Burbano]]></surname>
<given-names><![CDATA[David Felipe]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Fundación Valle del Lili Departamento de Ginecología y Obstétrica Unidad de Alta Complejidad Obstétrica]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad ICESI Facultad Ciencias de la Salud Postgrado en Ginecología y Obstetricia]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2018</year>
</pub-date>
<volume>86</volume>
<numero>9</numero>
<fpage>611</fpage>
<lpage>615</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0300-90412018000900611&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0300-90412018000900611&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0300-90412018000900611&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  ANTECEDENTES: Puesto que el embarazo heterotópico es poco común, representa un reto diagnóstico clínico y ecográfico que requiere un alto índice de sospecha. El enfoque terapéutico y la vía quirúrgica a elegir dependen de las condiciones clínicas y hemodinámicas de la paciente. Cuando las intervenciones son oportunas el embarazo intrauterino puede continuar y llegar a término.  CASO CLÍNICO: Paciente con embarazo intrauterino de 11.1 semanas que ingresó al servicio de Urgencias debido a sangrado vaginal, con signos clínicos de choque. La ecografía pélvica reportó, además del embarazo intrauterino, una imagen sugerente de embarazo heterotópico tubárico derecho y abundante cantidad de líquido libre. Se reanimó con hemocomponentes, laparotomía de urgencia, drenado de hemoperitoneo masivo. Requirió salpingectomía y resección del epiplón afectado, con buena evolución del embarazo intrauterino hasta el término  CONCLUSIONES: El tratamiento de elección del embarazo ectópico sigue siendo quirúrgico. La vía de acceso depende de las condiciones hemodinámicas de la pa-ciente. La laparoscopia es el patrón de referencia del tratamiento y la laparotomía es la opción cuando la laparoscopia no es posible por razones técnicas, logísticas, o por inestabilidad hemodinámica derivada de la ruptura tubárica.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  BACKGROUND: The heterotopic pregnancy is considered a rare condition that rep-resents a diagnostic challenge both clinical and ultrasound requiring a high index of suspicion, the therapeutic approach and the surgical route will depend on the clinical and hemodynamic conditions of the patient, being able to achieve a successful conti-nuity of intrauterine gestation when timely interventions are made.  CLINICAL CASE: Patient with a known diagnosis of intrauterine gestation of 11.1 weeks who was admitted to the emergency room due to vaginal bleeding, with clini-cal signs of shock and pelvic ultrasound that reports a suggestive image of right tubal heterotopic pregnancy and abundant free liquid. Resuscitation is performed with blood components and surgical management with emergency laparotomy, draining massive hemoperitoneum, requires salpingectomy and resection of omentum compromised, with good evolution and progression of intrauterine gestation to term  CONCLUSIONS: The treatment of choice for ectopic pregnancy remains surgical. The route of admission depends on the hemodynamic conditions of the patient. Laparoscopy is the reference standard of treatment and laparotomy is the option when laparoscopy is not possible due to technical, logistical or hemodynamic instability derived from tubal rupture.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Embarazo heterotópico]]></kwd>
<kwd lng="es"><![CDATA[hemoperitoneo]]></kwd>
<kwd lng="es"><![CDATA[embarazo tubario]]></kwd>
<kwd lng="es"><![CDATA[he-morragia uterina]]></kwd>
<kwd lng="en"><![CDATA[Heterotopic pregnancy]]></kwd>
<kwd lng="en"><![CDATA[Hemoperitoneum]]></kwd>
<kwd lng="en"><![CDATA[Tubal pregnancy]]></kwd>
<kwd lng="en"><![CDATA[Uterine hemorrhage]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cunningham]]></surname>
<given-names><![CDATA[FG]]></given-names>
</name>
</person-group>
<source><![CDATA[Williams Obstetrics]]></source>
<year>2015</year>
<edition>23rd</edition>
<page-range>345-57</page-range><publisher-loc><![CDATA[New York ]]></publisher-loc>
<publisher-name><![CDATA[McGraw-Hill]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Reece]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Combined intrauterine and extrauterine gestations: a review]]></article-title>
<source><![CDATA[Am J Obstet Gynecol]]></source>
<year>1983</year>
<volume>146</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>323-30</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Devoe]]></surname>
<given-names><![CDATA[WD]]></given-names>
</name>
<name>
<surname><![CDATA[Pratt]]></surname>
<given-names><![CDATA[JH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Simultaneous intrauterine and extrauteri-ne pregnancy]]></article-title>
<source><![CDATA[Am J Obstet Gynecol]]></source>
<year>1948</year>
<volume>56</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>1119-26</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chadee]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<source><![CDATA[Spontaneous Heterotopic Preg-nancy: Dual Case Report and Review of literature]]></source>
<year>2016</year>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kumar]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Dey]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
</person-group>
<source><![CDATA[Spontaneous heterotopic pregnan-cy with tubal rupture and pregnancy progressing to term]]></source>
<year>2013</year>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[Kuo-Hu]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[Li-Ru]]></given-names>
</name>
</person-group>
<source><![CDATA[Rupturing heterotopic pregnancy mimicking acute appendicitis]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Yu]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
</person-group>
<source><![CDATA[Management and outcome of 25 heterotopic pregnancies in Zhejiang, China]]></source>
<year>2014</year>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bou-Serra]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Morán]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Victoria]]></surname>
<given-names><![CDATA[C.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Gestación heterotópica espontánea. Diagnóstico ecográfico precoz y asintomático]]></article-title>
<source><![CDATA[Prog Obtet Ginecol]]></source>
<year>2011</year>
<volume>54</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>242-5</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Brunette]]></surname>
<given-names><![CDATA[DD]]></given-names>
</name>
<name>
<surname><![CDATA[Roline]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<source><![CDATA[Heterotopic pregnancy resulting from in vitro fertilization]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Perkins]]></surname>
<given-names><![CDATA[KM]]></given-names>
</name>
</person-group>
<source><![CDATA[Risk of ectopic pregnancy associated with assisted reproductive technology in the United States]]></source>
<year>2011</year>
</nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sturlese]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Heterotopic pregnancy: case report]]></article-title>
<source><![CDATA[Clin Exp Obstet Gynecol]]></source>
<year>2010</year>
<volume>37</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>69-72</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fatema]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<source><![CDATA[Heterotopic pregnancy with natural con-ception; a rare event that is still being misdiagnosed: a case report]]></source>
<year>2012</year>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hirose]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Combined intrauterine and ovarian preg-nancy: a case report]]></article-title>
<source><![CDATA[Asia Oceania J. Obstet. Gynaecol.]]></source>
<year>1994</year>
<volume>20</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>25-9</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Peleg]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Early diagnosis and successful nonsurgical treatment of viable combined intrauterine and cervical pregnancy]]></article-title>
<source><![CDATA[Fertil Steril]]></source>
<year>1994</year>
<volume>62</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>405-8</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Li]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<source><![CDATA[Management of Heterotopic Pregnancy Ex-perience From 1 Tertiary Medical Center]]></source>
<year>2017</year>
</nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Santamaría Marín]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Monroy Gómez]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<source><![CDATA[Gestación heterotó-pica: una causa infrecuente de abdomen agudo]]></source>
<year>2015</year>
</nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[César]]></surname>
<given-names><![CDATA[Mendivil]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Embarazo heterotópico: diagnóstico ecográfico temprano, manejo con laparoscopia: Reporte de un caso y revisión de la literatura]]></article-title>
<source><![CDATA[Rev Colomb Obstet Ginecol]]></source>
<year>2011</year>
<volume>62</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>98-103</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aranda Fortea]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Gestación heterotópica en un embarazo espontáneo]]></article-title>
<source><![CDATA[Prog Obstet Ginecol]]></source>
<year>2011</year>
<volume>54</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>524-7</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mustafa]]></surname>
<given-names><![CDATA[KB]]></given-names>
</name>
</person-group>
<source><![CDATA[Heterotopic triplet pregnancy with bi-lateral tubal ectopic post-IVF-ICSI of two 12-cell embryos]]></source>
<year>2015</year>
</nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Barrenetxea]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<source><![CDATA[Heterotopic pregnancy: two cases and a comparative review]]></source>
<year>2006</year>
</nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nahar]]></surname>
<given-names><![CDATA[MN]]></given-names>
</name>
</person-group>
<source><![CDATA[Comparison of transvaginal and tran-sabdominal ultrasonography in the diagnosis of ectopic pregnancy]]></source>
<year>2017</year>
</nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Siraj]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<source><![CDATA[Heterotopic pregnancy in a natural con-ception cycle presenting as acute abdomen: A case report and literature review]]></source>
<year>2014</year>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
