Heterotopic pregnancy (HP) refers to the simultaneous presence of intrauterine pregnancy (IUP) and ectopic pregnancy (EP), which is very rare but a potentially life-threatening condition. HP can be spontaneous or the subsequence of assisted reproductive technology (ART). A 23 years old patient, primigravida who came to the emergency department presenting lower abdominal pains for four days accompanied by moderate dark vaginal bleeding. The sonar reported Heterotopic Pregnancy. Laparotomy was performed and a clinically 13 week's fetus was found in the Pouch of Douglas. The other embryo that showed fetal activity and no other complication was left inside the uterus. The patient was seen in the hospital every month till delivered by cesarean section an alive baby. Heterotopic pregnancy is now more frequent because of reproductive assisted techniques. Doctors should keep a high index of suspicion in patients with intrauterine pregnancies accompanied by abdominal pains.

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