Live Birth after Treatment of a Ruptured Ectopic in a Spontaneous Heterotopic Pregnancy

Abstract

Heterotopic pregnancy, though more common in pregnancies achieved by assisted reproduction, is extremely rare following natural conception. Owing to this rarity, the diagnosis is oftentimes missed or made late, usually following rupture of the extrauterine gestation. Heterotopic pregnancy, therefore, expectedly carries significant maternal mortality and morbidity. With the advancement in assisted reproductive techniques, and   improvement in the diagnosis of ectopics using transvaginal ultrasound and beta‑human chorionic   gonadotropin assay, the frequency of heterotopic pregnancy is likely to increase, especially so in a country like Nigeria, with high twinning and ectopic pregnancy rates. To promptly diagnose heterotopic pregnancy and timely intervene, a high level of clinical suspicion is required. This would mitigate maternal morbidity and mortality, as well as preserve and continue the intrauterine pregnancy. With early diagnosis and prompt intervention, intrauterine pregnancy has a favourable outcome in the majority of cases. We present a  37‑year‑old multigravida with naturally conceived heterotopic pregnancy, in which the ectopic pregnancy ruptured. She subsequently had spontaneous vaginal delivery following surgical management (laparotomy) of
the ruptured ectopic pregnancy.