Heterotopic pregnancy: a case report about triplets

Heterotopic pregnancy refers to the concomitant presence of an intrauterine pregnancy and an ectopic pregnancy (EP). It is rare and more frequently found in women who have undergone medically assisted procreation. An abdominal location of the ectopic gestational sac is even less common, accounting for 1.4% of all ectopic pregnancies, conferring a high risk of morbidity and mortality. Diagnosis can sometimes be difficult, and pelvic ultrasound alone may not be sufficient. Additional pelvic MRI may be useful to confirm the diagnosis with certainty. Heterotopic pregnancy requires urgent management and is mainly treated surgically, although there are certain situations where medical treatment may be indicated. We report the case of a 29-year-old patient admitted with pelvic pain and mild metrorrhagia, with an elevated beta-hCG level suggesting the diagnosis of an EP, which was confirmed by ultrasound and MRI, revealing the presence of 3 foetuses: 1 was developing in the abdominal cavity while the other 2 were normally present in the uterine cavity.