Heterotopic pregnancy in a natural conception cycle

Introduction: Heterotopic pregnancy is a rare event in natural conception cycles. Diagnosis of heterotypic pregnancy requires a high index of suspicious. Described here in is a reported case of Heterotopic pregnancy presenting as adnexal mass.

Case: A young nulliparous woman with her last menstrual period 10 weeks before presentation complained of hypogastric pain beginning about 2 weeks ago. Initially the pain started from upper abdomen, then distributed to the hypo gastric region and then localized in LLQ accompanying with nausea. Transabdominal sonography diagnosed intra uterine 9.5 weeks live pregnancy with a heterogeneous mass with approximate diameter of 7 cm and moderate free fluid in pelvic cavity suggesting of torsion of left ovarian cyst or ectopic pregnancy. Emergency laparotomy revealed ruptured ectopic mass in the midportion of left fallopian tube. The uterus was soft and enlarged (a pregnant uterus). Salpingectomy was performed. Eventually a healthy baby was delivered at 37 weeks.

Conclusion: Although heterotopic pregnancy is a rare event, it should be considered in the situation of viable intrauterine pregnancy and tender adnexal mass.

Author(s): Anisodowleh Nankali, Farahnaz Keshavarzi , Taravat Fakheri

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