Abstract
Spontaneous heterotopic pregnancy is a rare clinical and potentially dangerous condition in which intrauterine (IU) and extra-uterine 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. Salpingectomy is the standard surgical approach of a coexistent tubal pregnancy and should be the first line of treatment in patients with hemodynamic instability or other signs of tubal rupture. In expert hands, an unruptured ectopic pregnancy can be treated with local feticidal injection under sonographic guidance.