Spontaneous Heterotopic Pregnancy and Its Clinical Implications

Heterotopic pregnancy is a rare but potentially life-threatening gynecologic emergency and is particularly uncommon in natural conceptions. Heterotopic pregnancies are prone to misdiagnosis due to the atypical clinical manifestations, especially after an intrauterine pregnancy has been confirmed.

A case involving a 31-year-old female who presented with persistent abdominal pain and tenesmus after a medical abortion for a naturally conceived pregnancy is discussed. The initial ultrasound confirmed an early intrauterine pregnancy but a repeat ultrasound revealed a right adnexal mass with an accumulation of pelvic fluid accumulation. Laparoscopic exploration confirmed a right tubal heterotopic gestation. The hysteroscopic examination revealed retained products of conception within the uterine cavity.The patient underwent hysteroscopic removal of the retained intrauterine products of conception and a laparoscopic right salpingectomy. The postoperative histopathologic evaluation corroborated the diagnosis. The patient recovered uneventfully.

This case is a reminder that confirmation of an intrauterine pregnancy does not exclude the coexistence of an ectopic pregnancy. Clinicians should maintain a high index of suspicion in patients with ectopic pregnancy risk factors, such as a history of multiple abortions, pelvic inflammatory disease, and/or endometriosis, or in patients who develop persistent or recurrent abdominal pain following an abortion. Early diagnosis and treatment of a heterotopic pregnancy can avert potentially life-threatening complications.