Ruptured heterotopic pregnancy: a rare cause for hemoperitoneum; report of three cases from kashmir, India

Heterotopic pregnancy has been found in various forms but is still a rare event in the natural conception cycles, occurring in less than 1:30000 pregnancies with the incidence rising to 1:100 to 1:500 pregnancies duo to assisted reproductive technologies. Delay in diagnosing the condition can be fatal for both the mother and the fetus. Three patients aged 28, 31 and 26 years presented with amenorrhea of ten, eight and twelve weeks duration respectively with signs of peritonism and shock. Investigations revealed intra and extra uterine pregnancies in all the three cases with the rupture of the extra uterine pregnancies. All the cases were operated and first two cases were followed up postoperatively till the delivery of the term live babies. The third case is still under our follow up. A high index of suspicion by a general surgeon is needed in arriving at a prompt diagnosis of ruptured heterotopic pregnancy so that rapid resuscitation, heart sparing anesthesia and expeditious surgery is carried out for both maternal and intrauterine fetal wellbeing.