Ruptured ectopic in a spontaneous heterotopic gestation; management and spontaneous vertex delivery of a live baby at term

Abstract

Heterotopic pregnancy is the simultaneous co-existence of an intrauterine and extrauterine pregnancy. It is uncommon and potentially dangerous occurring in 1:30,000 of natural conceptions. It carries a significant maternal morbidity and mortality including foetal wastage due to the risk of ectopic gestation. To report a case of ruptured ectopic in a spontaneous heterotopic gestation at 8 weeks of amenorrhoea. The case note of the patient was retrieved and the management reviewed. Relevant review of literature on the subject was also done. She was a 25 year old nullipara who presented at the accident and emergency unit of Rivers State University Teaching Hospital at 8 weeks gestation with two weeks history of lower abdominal pain with no associated bleeding per vaginam. There was haemoperitoneum from a ruptured tubal pregnancy co-existing with live intrauterine pregnancy diagnosed on ultrasound scan. She had emergency exploratory laparotomy and right partial salpingectomy. Intraoperative findings were haemoperitoneum of 1.5 litres, bulky uterus and right ruptured isthmic ectopic gestation. She did well post operatively and was discharged home to continue with antenatal care. She subsequently delivered a live male baby that weighed 3.4kg at term. Mother and baby were discharged in good clinical state. Clinicians must be alert to the fact that confirming an intrauterine pregnancy clinically or by ultrasound scan does not exclude the co-existence of an ectopic gestation. A high index of suspicion is needed for early diagnosis of heterotopic pregnancy even in the absence of risk factors; to prevent maternal mortality and have a favourable obstetric outcome.