Citation :

Mala Raj, Dhivya Venkatesan, Priyadharshini Karunakaran, Medha Laxmikant Karadi, "From Silent to Acute: Contrasting Presentations of Heterotopic Pregnancy following Assisted Reproduction," International Journal of Medical Science, vol. 13, no. 4, pp. 1-6, 2026. Crossref, https://doi.org/10.14445/23939117/IJMS-V13I4P101

Abstract

Heterotopic Pregnancy (HP), the coexistence of intrauterine and ectopic gestation, is a rare but increasingly encountered condition with the rise in Assisted Reproductive Techniques (ART). Early diagnosis remains challenging due to the presence of a concurrent intrauterine pregnancy, often leading to delayed recognition. We present two cases of heterotopic pregnancy with contrasting clinical presentations. The first case involved a 31-year-old G2P1L1 with ovulation induction conception presenting with minimal spotting and no abdominal pain. Ultrasound demonstrated a viable intrauterine pregnancy with a concurrent unruptured left tubal ectopic pregnancy. She underwent timely laparoscopic salpingectomy, with continuation of intrauterine pregnancy to term, resulting in a live birth. The second case involved a 30-year-old primigravida with ICSI conception presenting at 7+ weeks with acute abdominal pain and spotting per vaginum. Ultrasound revealed a viable intrauterine pregnancy along with a right adnexal mass and significant hemoperitoneum, suggestive of a ruptured ectopic pregnancy. Emergency laparoscopy confirmed the diagnosis, and salpingectomy was performed. These cases highlight the varied clinical spectrum of heterotopic pregnancy, ranging from asymptomatic to life-threatening presentations. Risk factors such as ART and ovulation induction necessitate a high index of suspicion. Transvaginal ultrasound plays a pivotal role in early diagnosis. Early recognition and prompt surgical management are crucial to prevent morbidity while preserving the intrauterine pregnancy. Clinicians must remain vigilant in high-risk patients to ensure favourable maternal and fetal outcomes.

Keywords

Heterotopic pregnancy, Assisted reproductive techniques, Tubal ectopic pregnancy, Laparoscopy, Case series.

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