Laparoscopic management of interstitial heterotopic pregnancy with preservation of intrauterine pregnancy and live birth outcome.

Abstract

We report a rare case of ruptured interstitial heterotopic pregnancy in a woman in her early 40s, conceived via in vitro fertilisation. The pregnancy was initially misdiagnosed as a dichorionic diamniotic intrauterine twin gestation. At 11 weeks 5 days of gestation, she presented with abdominal pain. Ultrasonography revealed a viable intrauterine fetus and a second gestational sac in the left interstitial region, with moderate haemoperitoneum. Emergency laparoscopy confirmed rupture of the interstitial ectopic with 1500 mL of haemoperitoneum. The ectopic sac was excised, and the uterine defect was repaired using a purse-string suture technique. Laparoscopy provided a minimally invasive approach with effective haemorrhage control. The intrauterine pregnancy progressed and culminated in the live birth of a preterm infant at 33 weeks 1 day. This case highlights the diagnostic challenges of interstitial heterotopic pregnancy and underscores the role of timely laparoscopic intervention in achieving a rare but successful maternal and neonatal outcome.