Double Heterotopic Pregnancy: Challenges in Diagnosis and Management

Heterotopic pregnancy is a rare complication; however, its incidence is increasing. Double heterotopic pregnancy is an even rarer and potentially life-threatening condition. It refers to a situation in which a pregnant woman has at least one intrauterine pregnancy along with two ectopic pregnancies. We report a case of double heterotopic pregnancy, comprising one intrauterine pregnancy and two ectopic pregnancies, one in each fallopian tube, in a 27-year-old woman. The diagnosis was confirmed during laparoscopic management of a presumed single heterotopic pregnancy, with intraoperative suspicion of a contralateral ectopic pregnancy. Conception occurred via intrauterine insemination following ovulation induction. The pregnancy subsequently resulted in a full-term vaginal delivery of a healthy male infant. Atypical forms of heterotopic pregnancy involving more than one ectopic gestation are extremely rare. Heterotopic pregnancy is life-threatening and poses significant challenges in both diagnosis and management, particularly in cases of double heterotopic pregnancy. An early and accurate diagnosis, along with timely management, whether medical or surgical, is key to a good prognosis and is considered life-saving for both the mother and the intrauterine pregnancy.