Spontaneous Heterotopic Pregnancy and Its Clinical Implications.

BACKGROUND

Heterotopic pregnancy is a rare but potentially life-threatening gynecologic emergency and is particularly uncommon in natural conceptions. Heterotopic pregnancies are prone to misdiagnosis due to the atypical clinical manifestations, especially after an intrauterine pregnancy has been confirmed.

CASE PRESENTATION: A case involving a 31-year-old female who presented with persistent abdominal pain and tenesmus after a medical abortion for a naturally conceived pregnancy is discussed. The initial ultrasound confirmed an early intrauterine pregnancy but a repeat ultrasound revealed a right adnexal mass with an accumulation of pelvic fluid accumulation. Laparoscopic exploration confirmed a right tubal heterotopic gestation. The hysteroscopic examination revealed retained products of conception within the uterine cavity.The patient underwent hysteroscopic removal of the retained intrauterine products of conception and a laparoscopic right salpingectomy. The postoperative histopathologic evaluation corroborated the diagnosis. The patient recovered uneventfully.

CONCLUSION

This case is a reminder that confirmation of an intrauterine pregnancy does not exclude the coexistence of an ectopic pregnancy. Clinicians should maintain a high index of suspicion in patients with ectopic pregnancy risk factors, such as a history of multiple abortions, pelvic inflammatory disease, and/or endometriosis, or in patients who develop persistent or recurrent abdominal pain following an abortion. Early diagnosis and treatment of a heterotopic pregnancy can avert potentially life-threatening complications.