IntroductionHeterotopic pregnancy (HP) is characterized by the existence of intrauterine and ectopic pregnancies occurring simultaneously(1). This is a rare yet serious condition that can be spontaneous or resultant from assisted reproductive technology (ART)(2). While spontaneous HP has a reported frequency of 1 in 50,000 to 1 in 10,000(3, 4), ART-related cases of HP have been estimated to occur in 0.2%-1% of patients(5). Heterotopic Cesarean scar pregnancy (HCSP) involves the occurrence of a Cesarean scar pregnancy (CSP) accompanied by intrauterine pregnancy (IUP), which poses a high risk of catastrophic complications such as uterine rupture and massive hemorrhage(6, 7, 8). An extremely low incidence of HCSP has been reported during spontaneous cycles. Nevertheless, due to the rising occurrence of Cesarean section delivery and the expanding recourse to ARTs, the prevalence of HCSP is anticipated to increase(9, 10, 11). Due to the considerable risk for fetal and maternal morbidity and mortality, timely and precise diagnosis of HCSP is vital(12). The principal investigative approach that holds the greatest significance involves sonographic and Doppler flow-based evaluations(13). In the management of HCSP, preserving the coexistent presents a significant challenge. Guidelines for managing HCSP while preserving the IUP are not universally standardized due to the rarity of this condition(14). The typical method is to terminate the implantation located within the scarred area, if deemed necessary, at the potential expense of terminating the IUP(7). The available literature reveals a range of techniques for managing this condition, with medical and surgical approaches being two distinct options. The surgical interventions, which may involve laparoscopic or hysteroscopic excision of the masses, have been linked with potential complications like the loss of pregnancy and preterm delivery. In our research, we detail a case of HCSP, which was addressed through a combination of exploratory laparotomy and dilation and curettage (D&C) procedures.

Background and aims: Venous thromboembolism (VTE) is a common complication of malignancy associated with a three-fold increase risk of death. Pregnancy is also a recognized risk factor for VTE, and is associated with a 4-5 fold increase risk compared to non-pregnant women. Considering that any review article has not been published in this field yet and given that complications of VTE can be reduced by early identifying between pregnant women the current systematic review aimed to elucidate the impact of malignancy on the risk of VTE in pregnant females. Methods: We carried out a systematic search in multiple databases, including PubMed (Medline), Google Scholar, and Scopus up to January 2023. Finally, 441 related articles were extracted from the databases, after screening the title, abstract and full text, seven articles were included in the study. Results: Seven studies (6 cohorts and 1 cross-sectional) with an entire of 58,854,195 pregnant females (22,396 cancer patients) were included. These studies were done in the United States of America, Canada, Brazil, and Denmark. All of the studies except one study demonstrated that cancer in pregnant patients increased the risk of deep vein thrombosis (DVT). The VTE prevalence was significantly higher in cancer groups compared with the non-cancer group and the highest (adjusted odds ratio) aOR was correlated to myeloid leukemia. Conclusions: Pregnant women with malignancy are more susceptible to VTE and other coagulation disorders. Physicians and health policymakers should be of high vigilance to pregnancy-associated VTE, especially in women suffering from cancer.