Laparoscopic Management of Spontaneous Heterotopic Pregnancy With Preservation of Intrauterine Pregnancy

Heterotopic pregnancy, defined as the coexistence of an intrauterine and an ectopic pregnancy, is a rare condition in spontaneous conceptions and may delay diagnosis. We report the case of a 33-year-old Rh-negative, non-alloimmunized woman with a history of cesarean section who presented with metrorrhagia and pelvic pain at 7+1 weeks of pregnancy. Initial transvaginal ultrasound showed a viable intrauterine pregnancy with a subchorionic hematoma and a FIGO type 5 fibroid, without evidence of ectopic pregnancy. During hospital follow-up for threatened miscarriage, persistent symptoms prompted a repeat ultrasound, revealing a right adnexal structure consistent with a second gestational sac with cardiac activity. Diagnostic laparoscopy confirmed a right tubal ectopic pregnancy, and laparoscopic salpingectomy was performed with preservation of the intrauterine pregnancy. The postoperative course was uneventful, and the patient achieved delivery at term by cesarean section. This case highlights the diagnostic challenge of heterotopic pregnancy, which may be missed despite confirmation of an intrauterine pregnancy, and underscores the importance of early clinical suspicion and timely intervention.