Naturally occurring heterotopic pregnancy with a monoamniotic monochorionic twin gestational pregnancy: a case report

We describe a case of a heterotopic pregnancy that included a rare spontaneous twin gestational monoamniotic monochorionic pregnancy in a patient with a history of questionable contraceptive practices and a previous left salpingectomy secondary to a ruptured ectopic pregnancy.

A 34-year-old woman, gravida 2, para 1001, at 9 weeks + 2 days' gestational age by her last menstrual period on etonogestrel vaginal ring contraception presented with progressively increasing right lower quadrant abdominal pain, increasing abdominal girth, and vaginal bleeding. Transvaginal ultrasound revealed an intrauterine pregnancy along with a ruptured right tubal pregnancy. The patient was taken to the operating room where a right salpingectomy was performed. Her main risk factor was a previous ectopic pregnancy that led to a left-sided salpingectomy 2 years prior to this incident.

Cesarean delivery was performed at 30 weeks + 2 days' gestation because of preterm premature ruptured membranes followed by preterm labor and a nonreassuring fetal heart tracing in the presenting fetus. Twin female infants were delivered. There was entanglement of the umbilical cords as well as 2 true knots.