Spontaneous haemoperitoneum in pregnancy (SHiP) is a rare but serious condition associated with an adverse pregnancy outcome. We present a case of previable twin pregnancy presenting with SHiP secondary to endometriosis, necessitating an emergency laparotomy and hysterotomy as a life-saving measure to achieve haemostasis. At laparotomy there was massive haemoperitoneum with active bleeding from the left fallopian tube and a left salpingectomy was performed. Histological examination showed haemorrhagic foci of endometriosis on the fallopian tube exhibiting florid stromal decidual change. We wish to raise awareness of this uncommon but potentially life-threatening condition requiring early recognition and prompt recourse to surgical intervention to minimise the morbidity and mortality.

We describe a case of a 31-year-old lady with primary subfertility who conceived only after her third intra-uterine insemination. She was diagnosed to have a right ectopic pregnancy which failed methotrexate treatment. Diagnostic laparoscopy confirmed bilateral ectopic pregnancies. A review was conducted for any consensus reached on diagnosis and optimal management of bilateral ectopic pregnancies after artificial reproductive techniques (ARTs). A search on Pubmed was carried out for publications in peer-reviewed journals with the following keywords: bilateral tubal ectopic pregnancy, heterotopic. Ten suitable publications were retrieved. Bilateral tubal ectopic pregnancy is rare, often missed on radiology and an unexpected finding at surgery. There should be a high index of suspicion for bilateral ectopic pregnancies after ART. Poor correlation with B-hCG levels further confuses diagnostic accuracy. It is prudent to ensure accurate diagnosis of bilateral ectopic pregnancies and appropriate intervention to reduce morbidity and mortality. Salpingostomy should be considered in patients with subfertility to preserve the possibility of future pregnancies.