912 Communications in brief

resistant diabetes insipidus of pregnancy. N Eng! J Med 1984;310,442).

REFERENCES

1. Hime MC, Richardson JA. Diabetes insipidus and preg­nancy: case report, incidence, and review of literature. Obstet Gynecol Surv 1978;33:375.

2. Ferrara JM, Malatesta R, Kemmann E. Transient neph­rogenic diabetes insipidus during toxemia in pregnancy. Diagn Gynecol Obstet 1980;2:227.

Double (uterine and ectopic) pregnancy of a patient using an intrauterine contraceptive device

Cesar Manuel Sisa, M.D.

School of Medicine, National University of Asuncion, Asuncion, Paraguay

This report presents a case considered to be an obstetric rarity: an intrauterine and an extrauterine pregnancy of a patient with an intrauterine contracep­tive device in place.

C. M. A., a 26-year-old primigravid patient, had a previous history of cesarean section for cephalopelvic disproportion. Ten months after the cesarean section an intrauterine con­traceptive device, Lippes Loop D, was inserted. Two months after the insertion she was hospitalized for heavy vaginal bleeding following a menstrual delay of 3 weeks.

The physical examination showed the intrauterine con­traceptive device in the correct place of insertion. The uterine cervix was soft and half open; upon palpation the uterus was found to be enlarged.

The probable diagnosis was incomplete spontaneous abor­tion. Removal of the intrauterine contraceptive device was followed with a curettage.

The pathologist's report confirmed the diagnosis of spon­taneous abortion. The patient was discharged the next day in good condition.

A week after the curettage the patient again complained of scant vaginal bleeding and cramping pain localized in the lower abdomen. She was given ethinyl nortestosterone acetate and ethinyl estradiol (Oral Primoteston) for 10 days. After 48 hours of treatment the bleeding stopped.

A month later the patient reported copious vaginal bleed­ing. Another curettage was performed in which several clots were removed. A puncture of the posterior fornix was per­formed with negative results.

Examination with the patient under anesthesia revealed a small mass in the right lower quadrant. It was thought to be in the right ovary.

The second pathology report on the clots referred to "en­dometrial tissue with signs of progesterone treatment" with­out an Arias-Stella image.

Five days after the last curettage the patient was admitted with abdominal pains, vaginal bleeding, weakness, and dizzi­ness. An extrauterine pregnancy was suspected and a laparos­copy was performed. A ruptured right tubal pregnancy was found. A salpingectomy was then performed.

Reprint requests: Cesar Manual Sisa, M.D., School of Medicine, National University of Asuncion, Meal. Estigraribia 1851, Asuncion, Paraguay.

August 15, 1984 Am. J. Obstet. Gynecol.

The pathology report read "ectopic pregnancy in the right fallopian tube." The patient was discharged 5 days after the operation in very good condition.

A case such as the one described here is very seldom seen, but it can result in serious and fatal consequences because the rarity of its occurrence leads to an un­awareness by the physician who does not consider this as an exceptional possibility.

Because of the reliability of the patient, we are cer­tain that she did not have intercourse after the first curettage. This fact invalidates the possibility of an ec­topic pregnancy occurring after her normal preg­nancy.

One comment that can be made is that a laparoscopy should have been performed along with the second curettage as an auxiliary diagnostic procedure, but it was not done because abundant clots were obtained and because the Douglas puncture, as well as palpation under anesthesia, gave negative results.

International literature related to this specific type of complication is very scarce. References are numerous, however, in relation to other pregnancy complications, either normal or extrauterine, in the use of in­trauterine contraceptive devices. 1

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The above case, describing use of an intrauterine contraceptive device (Lippes Loop D) with both a tubal and a uterine fetus not completely expelled along with nonexpulsion of the intrauterine contraceptive device, is an obstetric rarity. Therefore, physicians usually do not foresee this serious event.

REFERENCES

1. Beck A. Intrauterine device: complications and diagnosis in 1000 patients. Int J Gynecol Obstet 1970;8:528.

2. Wiles PJ, et al. Pregnancy complicated by intrauterine de­vices. Obstet Gynecol 1974;44:484.

3. Davis HJ. Intrauterine contraceptive devices. Present status and future prospect. AM j 0BSTET GYNECOL 1972;ll4:134.

Erythrocytapheresis in pregnant patients with sickle hemoglobinopathies

J. C. Morrison, M.D., S. G. Douvas, M.D., J. N. Martin, Jr., M.D., P. G. Blake, R.N., B.S.N., W. L. Wiser, M.D., M. C. Durham, R.N., and F. S. Morrison, M.D.

Division of Maternal/Fetal Medicine, Department of Obstetrics and Gynecology, and Division of Hematology, Department of Internal Medicine, The University of Mississippi Medical Center, Jackson, Mississippi

Supported in part by the Vicksburg Hospital Medical Foundation.

Third Prize Award Paper, presented at the Annual Clinical Meeting of the American College of Obstetricians and Gynecologists, Dallas, Texas, April 24, 1982.

Reprint requests: J. C. Morrison, M.D., Division of Mater­nal/Fetal Medicine, Department of Obstetrics and Gynecol­ogy, The University of Mississippi Medical Center, 2500 North State St., Jackson, MS 39216.