Heterotopic pregnancy in natural conception – A case report

Abstract

Introduction: Heterotopic pregnancy is the coexistence of living or dead intrauterine pregnancy, single or multiple, and extra-uterine pregnancy located in the oviduct, ovary, uterine cornua, cervix or peritoneal cavity. Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. A high index of suspicion can help in timely diagnosis and appropriate intervention.
Case report: A 37- year-old primigravida lady with spontaneous pregnancy presented with amenorrhoea of 5 weeks, sudden and increasing lower abdominal pains of 5 days, dizziness of 2 days and vaginal bleeding of 4hours. Transabdominal and Transvaginal ultrasound scan was performed and revealed a non-viable intrauterine gestation at 6 weeks and 3 days, associated with a heterogenous complex right adnexal mass. Laparotomy was done, it revealed a ruptured right fallopian tube with remnant products of conception and hemoperitoneum; and right salpingectomy was done. The specimen was sent for histopathology. The patient tolerated the procedure well, though was resuscitated with normal saline and blood transfusion; she was taken to the recovery room in stable condition. The histopathological report confirmed the diagnosis of ectopic pregnancy.
Conclusion: Despite the rarity of heterotopic pregnancy it should be suspected in patients with hemoperitoneum and an adnexal mass, even in the absence of risk factors, and should be included in the differential diagnosis of acute abdomen in the first trimester. The patient should be thoroughly investigated using abdominal and transvaginal ultrasound to exclude this rare diagnosis and allow on-time proper management.