A “Two-bal” Pregnancy: A Case Report on Heterotopic Pregnancy

Abstract

Heterotopic pregnancy is defined as the combination of an intrauterine pregnancy and a concurrent pregnancy with an ectopic location, often the fallopian tube. Implantation can also occur in the cervix, ovary, cornua, abdomen, and previous Cesarean scar . While heterotopic pregnancy is considered a rare finding, the incidence is increasing due to the increased use of Assisted Reproductive Technology (ART). Heterotopic pregnancy is suspected when an ultrasound reveals an intrauterine pregnancy in addition to a complex adnexal mass. Differential diagnoses include: threatened abortion, ruptured corpus luteum cyst, and isolated ectopic pregnancy. Correct diagnosis can be difficult to attain due to nonspecific symptoms and findings such as: free fluid in the abdomen, abdominal pain, and vaginal bleeding. Patients are often diagnosed later than in an isolated tubal pregnancy due to these nonspecific symptoms and confirmation of an intrauterine pregnancy . Delayed diagnosis often leads to greater risk of rupture, an acute abdomen, and hemodynamic instability. Since the extrauterine pregnancy is non viable, salpingectomy is the surgical standard and first line treatment . However, other treatment modalities such as local feticidal injection have been performed depending on the clinical status of the patient and physician expertise. Finally, an ultrasound is to be performed after the procedure to confirm viability of the intrauterine pregnancy. During this case study, the patient presentation, diagnosis, and treatment of heterotopic pregnancy will be discussed in detail. The objective of this case study is to review the events and management of this unique patient presentation and discuss the recommended diagnosis and treatment options, as well as the incidence and prognosis of patients with this rare diagnosis.