Spontaneous Heterotopic Pregnancy in a Primigravida: A Case Report

Heterotopic pregnancy is the coexistence of an intrauterine pregnancy and an ectopic pregnancy.It is uncommon after spontaneous conception and may be overlooked once a normal intrauterine pregnancy has been identified.We report the case of a 33-year-old primigravida at approximately seven weeks of gestation who presented to the emergency department with sudden severe lower abdominal pain radiating to the back.Conception had occurred spontaneously, without assisted reproductive technology.Pelvic ultrasonography demonstrated a viable intrauterine pregnancy together with a separate viable left tubal pregnancy and free intraperitoneal fluid.Initial investigations showed microcytic anemia, with a hemoglobin concentration of 7.6 g/dL and a mean corpuscular volume of 66.6 fL.Laparoscopy demonstrated approximately 150 mL of hemoperitoneum and a macroscopically unruptured left tubal ectopic pregnancy with a fimbrial hematoma.A left salpingectomy was performed while preserving the intrauterine pregnancy.Histopathologic examination of the excised tube confirmed chorionic villi.Recovery was uncomplicated, and ultrasonography the following day confirmed continued viability of the intrauterine pregnancy.Subsequent first-trimester follow-up showed appropriate progression.The intrauterine pregnancy continued to term, with cesarean delivery of a live male infant at 39 weeks and four days for breech presentation in labor.This case emphasizes that identification of an intrauterine pregnancy should not end the evaluation of a pregnant patient with significant abdominal pain.Careful assessment of the adnexa remains important even after spontaneous conception.