Heterotopic Pregnancy: A Case Report

Spontaneous heterotopic pregnancy is a rare clinical and potentially dangerous condition in which intrauterine (IU) and extrauterine pregnancies occur at the same time. It can be a life-threatening condition and can be easily missed, with the diagnosis being overlooked. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low-risk women with an IU gestation who have free fluid with or without an adnexal mass or in those presenting acute abdominal pain and shock. The ectopic component is usually treated surgically and the IU one is expected to continue normally. G5P5 patient 35 year old patient reported to our emergency with chief complaints of bleeding per vaginum and pain abdomen since four hours. She was 12 weeks on the day of her examination. This was her spontaneous conception and all her previous deliveries were full term normal vaginal deliveries. Her history does not suggest and intrapartum or postpartum complications. Her medical history suggests history of pelvic inflammatory disease for which she took medical treatment. there is no history of any abortion or infertility treatment. On examination her vitals were blood pressure 80/60 mm Hg and pulse rate 100 / min. On per abdomen examination she had guarding, tenderness and rebound tenderness. On per vaginum examination uterus was 12 weeks size, cervical os closed with bleeding. Right forniceal tenderness was present and cervical motion tenderness present. She was resusicated and her necessary lab investigations were sent. Her hemoglobin was 8 gm/dl and rest of the reports were within normal range. Her ultrasound report of the same day showed intrauterine pregnancy of 12 weeks gestation with cardiac activity and right adnexal mass 4*4 cm with increased colour doppler flow. There was free fluid in pelvis. Decision for explorative laparotomy was taken with consent and blood was arranged for her. per operative findings were right sided ampullary ruptured ectopic and 12 week size uterus. There was 2 litre of hemoperitoneum. Right salpingectomy and left sided tubal ligation by modified pomeroys done. Hemoperitoneum was removed. she received four units of blood transfusion intra and post operatively and ICU care was given. Patient was stable and withstood the procedure well. Suction evacuation was done and all the tissues sent for histopathology. Histopathology of tube confirmed chorionic villi suggestive of ectopic pregnancy and suction evacuaton products report confirmed products of conception.