Heterotopic Pregnancy with an Intrauterine Twin Gestation and Ruptured Tubal Pregnancy: An Unusual Presentation

Abstract

Heterotopic pregnancy is diagnosed as coexistent presence of fetuses at two or more implantation sites. Its incidence is very rare with presence of live intrauterine twins being even rarer. Diagnosis in such cases is difficult with ultrasound being the investigation of choice. Management is primarily surgical. It is a clinical entity which is becoming even more common with widespread use of assisted reproductive techniques. A 20-year-old primigravida with 10 weeks of gestation presented with sudden onset pain on right side of abdomen. She had history of treatment for infertility for 1 year. Ultrasound revealed live intrauterine twin pregnancy with a heterogeneous lesion in right adnexal region and peritoneal free fluid. In concordance with clinical findings a diagnosis of heterotopic pregnancy with ruptured ectopic was made. Patient was managed through emergency laparotomy without disturbing the intrauterine twin gestation. Higher incidence of heterotopic pregnancy has been observed in patients undergoing assisted reproductive techniques and therefore warrant regular and detailed examination and follow up to avoid complications like ruptured ectopic pregnancy.

Untitled

“…2 On the other hand implantation can also occur in the cervic, cornu, or in the abdomen. 1 In this case implantation occur in intrauterine and intraabdomen, where the fetus is embedded in the omentum so that the right and the left adnexa are still in normal condition.…”

“…Heterotopic pregnancy is pregnancy characterized by coexistence of an ectopic pregnancy and an intrauterine pregnancy in the same patient. 1 The first case was found in 1708 by Duvernet, at that time diagnosis was established during autopsy. 2 Heterotopic is very rare case but it is also potentially lifethreatening.…”