The unfortunate twin: A case report of intrapartum diagnosis of heterotopic pregnancy

Abstract

Heterotopic pregnancy is a rare condition characterized by the simultaneous presence of both an intrauterine and an ectopic pregnancy. Most cases are identified during the first trimester. This report describes the case of a woman in labor who presented with right lower quadrant abdominal tenderness. During a cesarean section performed for an obstetric indication, a tubal ectopic pregnancy with active ostial bleeding and 600 ml of hemoperitoneum was discovered. A salpingectomy was performed, and histopathology confirmed the diagnosis of tubal ectopic pregnancy. The patient was discharged on the third day of admission with stable vital signs. This is seemingly the first ever reported case of a tubal heterotopic ectopic pregnancy presenting intrapartum.

Keywords: Ectopic pregnancy; Hemoperitoneum; Heterotopic pregnancy.

Fig. 1

Intraop picture of the intact gravid uterus (blue arrow), tubal ectopic pregnancy (green arrow), and active ostial bleeding (black arrow).

Fig. 2

A picture of the tube after salpingectomy with the tubal ectopic pregnancy (yellow arrow).