Quadruplet Heterotopic Pregnancy : A Case Report

Abstract

Background: Heterotopic pregnancy is a condition in which pregnancy occurs synchronously intrauterine and extrauterine. The estimated incidence following spontaneous conception is below 1/30,000. On the other hand, the incidence in artificial reproductive techniques has been reported to be as high as 1/100. Case: This case report is of a 20 year old woman, nulliparous, who presented to the emergency department with acute abdominal pain post ovulation induction with human menopausal gonadotrophins and intrauterine insemination. Examination revealed acute surgical abdomen. Ultra-sonographic examination showed viable triplet intrauterine gestation of 10 weeks and presence of right complex adnexal mass. Laparotomy was done and the patient was found to have right tubal ectopic pregnancy that was managed by salpingostomy. Post operative period was uneventful and patient was discharged with viable three embryos and she was followed as an outpatient in a high risk pregnancy clinic. Comment: Though the incidence of heterotopic pregnancy is low following spontaneous pregnancy but a high index of suspicion must be considered in any patient with intrauterine pregnancy who presented with abdominal pain and adnexal mass and particularly if conception occurs after artificial reproductive techniques. This approach would avoid maternal morbidity and mortality.