Heterotopic Pregnancy after Natural Conception: A Case Report

Heterotopic pregnancy (HP), i.e. the simultaneous development of an intrauterine and an ectopic pregnancy, is rare with a reported incidence of between 1 : 2600 and 1 : 30 000. Only a few cases have been described in the literature. We report here on an extremely rare case of HP after natural conception with cardiac activity noted on sonography in both the intrauterine and the ectopic foetus. Examination excluded appendicitis. Vaginal sonography (VS) was performed and revealed a second, extrauterine foetus with cardiac activity. The differential diagnosis included twin pregnancy in a bicornuate uterus, but HP could not be excluded. Diagnostic laparoscopy was scheduled due to progressive abdominal pain. Shortly before surgery the patient became acutely hypotensive. Laparoscopy confirmed a heterotopic pregnancy in the right tube. Due to acute rupture of the extrauterine pregnancy with intraabdominal bleeding, the procedure was converted to a laparotomy with right-sided salpingectomy. Subsequently, the intrauterine pregnancy continued without complications. The intrauterine pregnancy was uneventful with spontaneous delivery at term.