Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Heterotopic pregnancy (HP) with coexisting intrauterine pregnancy (IUP) represents a rare but clinically complex obstetric condition, particularly due to elevated risks of early pregnancy loss following surgical intervention. This study aims to evaluate the clinical characteristics and identify risk factors for postoperative IUP loss in HP patients, thereby informing clinical decision-making and future research. <bold>Methods:</bold> This retrospective study conducted 102 cases of surgically treated HP at Guangdong Women and Children Hospital from January 2013 to January 2023. Data included demographics, clinical presentations, surgical details, and pregnancy outcomes of HP patients. Univariate and multivariate logistic regression models were applied to identify predictors of IUP miscarriage within 12 postoperative weeks. <bold>Results:</bold> In a cohort of 102 patients diagnosed with HP, 14 (13.73%) experienced miscarriage following surgical treatment. Univariate analysis identified several significant factors influencing IUP miscarriage, including the surgical pathway, surgical method, preoperative IUP fetal cardiac activity, intraoperative bleeding, intraoperative uterine manipulation, postoperative miscarriage prophylaxis and changes in human chorionic gonadotropin(HCG) levels before and after surgery (P<0.05). Further multivariate analysis demonstrated the presence of preoperative fetal cardiac activity in IUP (OR:0.028, 95%CI: 0.002-0.330, P=0.004) and the ratio of postoperative HCG within 24 hours and preoperative HCG within 24 hours (postoperative HCG/preoperative HCG) ≥ 1/3 (OR: 0.012, 95%CI: 1.63×10 <sup>-4</sup> -0.916, P=0.046) as independent protective predictors of postoperative continued pregnancy. C <bold>onclusions:</bold> Laparoscopic intervention constitutes a viable alternative for HP management, while unnecessary uterine manipulation should be minimised. Preoperative fetal viability and stable HCG dynamics are protective predictors against intrauterine pregnancy loss. Early ultrasound diagnosis and optimized surgical protocols are pivotal for improving maternal and feta outcomes in HP. </p>