Presentation
The patient is a G1P1 presenting with abdominal pain and cramping. The pregnancy test is positive with no history of pelvic inflammatory disease or prior ectopic pregnancy.
Patient Data
Ultrasound was obtained to rule out an ectopic pregnancy.
Ultrasound demonstrates two gestational pregnancies, both with fetal cardiac activity. The intrauterine gestational sac can be seen with a decidual reaction circumferentially around it. The fetal crown-rump length is 5mm, consistent with 6-week gestation and compatible with the patient's LMP. There is also a perisac hematoma of about 8cc.
The other gestational sac is located in the right adnexal region, consistent with ectopic pregnancy.
No free fluid is seen in the cul-de-sac.
Case Discussion
This case illustrates a heterotopic pregnancy, which occurs when both an extra-uterine (ectopic pregnancy) and an intrauterine pregnancy happen simultaneously.