Presentation
Pregnant patient in the first trimester presents with acute abdominal pain starting two hours ago.
Patient Data
In heterotopic pregnancy, both fetuses with heart activity, one fetus located in the uterine cavity (HR 168 bpm) and another in the right adnexal region (HR 184 bpm).
Gestational age of 11 weeks and 5 days based on the CRL of the intrauterine fetus.
Free fluid in the pelvic cavity extends to the hepatorenal and splenorenal spaces.
This sonogram was performed two days after the salpingectomy. The intrauterine fetus does not show abnormalities.
Fetal heart rate (FHR): 163 bpm. Crown-rump length (CRL): 52.2 mm, estimating gestational age of 11 weeks and 6 days (+/- 5 days).
Small amount of free fluid in the pouch of Douglas.
Case Discussion
Following the ultrasonographic evaluation, the patient was promptly taken to the operating room, where a salpingectomy was performed.
The significant amount of intraperitoneal hemorrhage led to a decline in hemoglobin levels to 7 g/dL, necessitating the administration of two units of packed red blood cells.
Heterotopic pregnancy, defined as the concurrent presence of intrauterine and extrauterine gestations, represents a rare but clinically significant condition. The incidence varies considerably depending on the involvement of assisted reproductive technologies (ART). In spontaneous pregnancies, such as in this case, the incidence is estimated to range between 1 in 8,000 and 1 in 30,000 pregnancies 1. In contrast, ART, particularly in vitro fertilization (IVF), markedly elevates the risk, with reported incidences reaching up to one percent of pregnancies achieved through these methods 2.
This case highlights the importance of maintaining a high index of suspicion for heterotopic pregnancy, particularly in patients presenting with acute abdominal pain in the first trimester, even in the absence of ART history.
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