Heterotopic pregnancy

Last revised by Henry Knipe on 24 Jan 2023

Heterotopic pregnancy is a rare situation when there is an intra-uterine and extra-uterine (i.e. ectopic) pregnancy occurring simultaneously.

The estimated incidence in the general population is estimated at 1:30,000 (for a naturally conceived pregnancy 7). The incidence among patients with assisted reproduction is higher and is thought to be around 1-3:100 2. Due to this, the overall incidence has increased over the years.

Heterotopic pregnancies have been diagnosed from 5-34 weeks of gestation with up to 70% diagnosed between 5-8 weeks of gestation, 20% between 9-10 weeks, and only 10% after the 11th week 6.

Recognized risk factors predisposing to this condition include:

Classically shows features of an intra-uterine pregnancy as well as an ectopic pregnancy.

An ultrasound-guided ablation or laparoscopic removal of the extra-uterine fetus can be considered in patients who have a known heterotopic pregnancy to permit the intrauterine pregnancy to continue normally.

Medical management, although used successfully for an ectopic pregnancy, has a limited role in the management of heterotopic pregnancy as one must try to preserve and protect the intrauterine pregnancy.

Considerations include:

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 5: rupture (MRI)
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  • Case 6
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