Catastrophic presentation of spontaneous heterotopic pregnancy

Abstract

Heterotopic gestation is an uncommon entity with natural conception; however, rising trends have been seen with the use of artificial reproductive techniques. We are reporting a case of 22-year-old G3P1A1L1 who presented to us at 9 weeks of gestation with complaints of mild pain in the left adnexa from 3 days. Subsequently, her pain was increased in intensity and spread over to whole abdomen. She was referred with the left adnexal mass with persistent pain abdomen. On admission, ultrasound revealed single live intrauterine fetus with the left adnexal mass with fetal node along with hemoperitoneum. She underwent laparotomy and successfully managed with the left side salpingectomy along with blood transfusion. Later, she delivered a healthy baby at term. Ectopic pregnancy should be the first differential diagnosis when no other cause suspected in patients with adnexal mass. Follow-up ultrasound should be done in patients with persistent and localized pain in abdomen even in spontaneous conception. Diagnostic laparoscopy may be the reasonable option to make a final diagnosis as beta-human chorionic gonadotropin is not a reliable test to diagnose ectopic pregnancy in heterotopic pregnancy.