Heterotopic pregnancy in the absence of risk factors--diagnostics difficulties.

Heterotopic pregnancy (HP) is a rare entity occurring in 1:30000 pregnancies but its incidence raises as a result of assisted reproductive techniques (ART) to 1:100-1:500. The aim of this report was to present a rare case of simultaneous intrauterine and extrauterine tubal pregnancy in a natural conception cycle. The ectopic pregnancy was not diagnosed in the first trimester scan and at 14 and 16 weeks of gestation led to severe hemoperitoneum and two exploratory laparotomies. Diagnostic problems were discussed and literature was reviewed.