Heterotopic pregnancy in a natural conception cycle presenting as hematometra

Heterotopic pregnancy is a rare event in natural conception cycles. Diagnosis of heterotopic pregnancy requires a high index of suspicion. Described herein is a reported case of a heterotopic pregnancy presenting as hematometra.

A young, multiparous woman, with her last menstrual period 6 weeks before presentation, complained of a dark reddish-brown vaginal discharge and progressive left lower-quadrant discomfort during early pregnancy following a natural conception cycle. An intrauterine mass was observed, and subsequently a heterotopic pregnancy complicated by hematometra was diagnosed with the help of transvaginal ultrasonography and 3-dimensional power Doppler ultrasound angiography.

Women with intrauterine fluid accumulation during pregnancy may be at risk for coexistent ectopic pregnancy. High resolution transvaginal color Doppler sonography may be useful to identify a heterotopic pregnancy preoperatively.