Is heterotopic pregnancy uncommon?

Abstract

Introduction A heterotopic pregnancy is a multifetal pregnancy with the presence of a combined intrauterine and ectopic pregnancy. Its estimated incidence is accepted as between 1/7000 and 1/30,000 pregnancies. It is also reported to be as high as 1% after the use of assisted reproductive technology, Heterotopic pregnancies are diagnostic and therapeutic challenges for obstetricians. If they continue without diagnosis, a life-threatening situation may arise. The presentation of heterotopic pregnancy is at variance in presentation of classical disturbed tubal ectopic pregnancy. Case presentation We present two cases of early pregnancies that developed a simultaneously extra -and intrauterine pregnancy following spontaneous conception .In both the cases, there was diagnostic dilemma due to earlier ultra sound reports of normal single intrauterine pregnancy. In the first case patient had presented with history of amenorrhoea, colicky pain in abdomen, inability to lie in supine dorsal position, with features of intra peritoneal haemorrhage without any vaginal bleeding. In the second case, the patient had amenorrhoea with pain in right iliac region along with earlier ultrasound confirmed intra uterine pregnancy. Surgical intervention was done and intrauterine pregnancy could be salvaged. Conclusion These cases suggest that heterotopic pregnancy must always be considered in patients presenting with pelvic pain even in a confirmed intrauterine pregnancy, even with no induction of ovulation. Every clinician treating women of reproductive age should keep this diagnosis in mind. It also demonstrates that early diagnosis is essential in order to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality.