Ruptured Heterotopic Pregnancy Presenting With Hemorrhagic Shock.

Heterotopic pregnancy is an uncommon and potentially life-threatening condition that presents a significant diagnostic challenge, particularly in spontaneous conceptions. We describe the case of a 38-year-old multigravida who presented to the emergency department with acute abdominal pain and signs of hemorrhagic shock. Point-of-care transabdominal ultrasound revealed a moderate volume of intraperitoneal free fluid with echogenic content, raising suspicion for hemoperitoneum or peritonitis, and also demonstrated a viable intrauterine pregnancy at nine weeks' gestation. Emergency laparoscopy confirmed a ruptured ectopic pregnancy in the right fallopian tube, requiring salpingectomy and peritoneal lavage. Despite initial maternal stabilization, intrauterine fetal death was confirmed on the first postoperative day. This case underscores the need for heightened clinical suspicion in symptomatic pregnant patients, even when an intrauterine pregnancy has been documented and typical risk factors are absent. Timely diagnosis and prompt surgical management remain critical to optimize maternal outcomes.