Spontaneous Heterotopic Pregnancy: A Case Report and Review of Radiological Assessment and Diagnostic Challenges

Heterotopic pregnancy is the simultaneous occurrence of intrauterine and extrauterine gestation. It is a rare complication of gestation more common when conception is achieved by assisted reproduction techniques than in natural conceptions. Heterotopic pregnancy is a life-threatening pathology with the diagnosis often missed radiological investigations due to its rarity. A painstaking sonographic evaluation is required to rule out the presence of heterotopic gestation and thus help in prompt diagnosis and appropriate management. Early diagnosis of this pathology reduces the incidence of complications as well as maternal mortality. We hereby report a case of heterotopic pregnancy presenting with gestation amenorrhea of seven weeks and acute pain in the lower abdomen associated with episodes of spotting per vagina of three days duration. The diagnosis of heterotopic pregnancy with ruptured extrauterine gestation was made on a careful ultrasound examination and was managed with exploratory laparotomy. The intrauterine pregnancy course was uneventful with a delivery of a live baby at term. This case report emphasizes the need to carefully examine the adnexa even with the visualization of normal pregnancy on ultrasound interrogation to rule out heterotopic pregnancy.