Spontaneous Heterotopic Pregnancy Presenting with Hemoperitoneum

Heterotopic pregnancy is a condition in which intra- and extrauterine pregnancies occur at the same time. Spontaneous heterotopic pregnancy is a rare event, with incidences ranging from 1 in 30,000 pregnancies to as high as 1 in 6 pregnancies assisted by reproductive technology.

A 34-year-old woman presented with a 10-week history of amenorrhea, pelvic pain, and generally feeling unwell. Ultrasonography revealed a 10-week intrauterine viable pregnancy and free fluid in the abdominal cavity. Emergency laparotomy was performed and a ruptured tubal ectopic pregnancy was encountered on the right tube with hemoperitoneum. Salpingectomy was performed. Her intrauterine pregnancy was intact with positive fetal cardiac activity when she was discharged. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Heterotopic pregnancy should be kept in the differential diagnosis of any patient with an intrauterine pregnancy presenting with abdominal pain, abdominal tenderness, or free fluid in the abdominal cavity.