Combined intra- and extrauterine pregnancy. A diagnostic challenge

A case of combined intrauterine and tubal pregnancy is reported and illustrates the difficulties of correctly diagnosing combined pregnancy. The patient had no signs or symptoms suggestive of a tubal pregnancy at the time of termination of the intrauterine pregnancy. She underwent two repeat uterine evacuation procedures, an ultrasonic examination and a diagnostic laparoscopy before the unruptured tubal pregnancy was diagnosed. Both pregnancies probably occurred during the same menstrual cycle.