Heterotopic Pregnancy Presenting as Maternal Acute Abdomen at 19 Weeks of Gestation: A Case Report

Behrokh  Sahebdel; Mohammad Hossein  Golezar; Azita  Zare; Fatemeh Golshahi; Nafiseh  Saedi; Mahboobeh  Shirazi

doi:10.18502/crcp.v10i2.19901

Behrokh Sahebdel Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Hossein Golezar Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Tehran University of Medical Sciences, Tehran, Iran
Azita Zare Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran.
Fatemeh Golshahi Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran.
Nafiseh Saedi Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
Mahboobeh Shirazi Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/crcp.v10i2.19901

Keywords: Heterotopic pregnancy; Abdominal pain; Ruptured ectopic pregnancy

Abstract

Heterotopic pregnancy is the simultaneous presence of intrauterine and ectopicgestations. It is typically diagnosed in the first trimester via sonography or when patientspresent with vaginal bleeding or abdominal pain. We report a case of a 26-year-oldAsian primigravida woman who conceived through ovulation induction and presentedat 19 weeks and 4 days of gestation—one week after a successful Macdonald cerclage,with severe abdominal pain and hemodynamic instability. Bedside ultrasoundrevealed significant hemoperitoneum and a viable intrauterine fetus. Emergencylaparotomy identified an unruptured right fallopian tube containing a 5 × 6 cm mass.A right salpingectomy was performed due to suspected ectopic pregnancy, and noother bleeding source was found. Histopathology confirmed tubal ectopic pregnancy.The postoperative course was uneventful, and the intrauterine pregnancy successfullyprogressed to term. Heterotopic pregnancy should be considered in the differentialdiagnosis of hemoperitoneum, even in the second trimester.