Heterotopic pregnancy: should we instrument the uterus at laparoscopy for ectopic pregnancy

The coexistence of intrauterine and ectopic pregnancy (heterotopic pregnancy) occurs in 1/30,000 of spontaneous pregnancies. However, it is getting more common at 1/900 in clomiphene citrate-induced pregnancies and rises to 1% in assisted reproduction. It is a potentially life-threatening condition with diagnostic and therapeutic complexities. Our patient is a 40-year-old who has been trying to get pregnant for 3 years. A planned non-instrumentation of the uterus at laparoscopy despite clear signs of a ruptured ectopic pregnancy has given her a chance of a continuing intrauterine pregnancy. With the increasing number of in vitro fertilisation-embryo transfers, the incidence of heterotopic pregnancies is also increasing, hence issues discussed here is whether the uterus should be instrumented at all during laparoscopy in early pregnancy and misdiagnosis with its sequel.