When rupture does not end the story, successful term birth after heterotopic pregnancy: A case report

When rupture does not end the story, successful term birth after heterotopic pregnancy: A case report DOI: https://doi.org/10.71152/ajms.v16i11.4838Keywords: Heterotopic pregnancy; Ruptured ectopic pregnancy; Ovulation induction; Adnexal mass; Term deliveryAbstract Heterotopic pregnancy (HP) is the simultaneous coexistence of intrauterine and extrauterine gestations. It is rare, with an incidence of 1 in 30,000 in spontaneous conceptions, but up to 1 in 100 in assisted reproductive techniques. Diagnosis is often difficult in low-resource settings without high resolution ultrasonography. A 23-year-old primigravida, who conceived after two cycles of ovulation induction, presented at 6 weeks of gestation with worsening abdominal pain for 2 days. On admission, she was tachycardic, hemodynamically unstable, and in shock. Ultrasonography demonstrated a left adnexal mass, hemoperitoneum, and a viable intrauterine pregnancy (IUP) of 6–7 weeks. After arranging two units of cross-matched blood, an emergency laparotomy was performed. Intraoperative findings included a ruptured left ampullary ectopic pregnancy with approximately 900 mL of hemoperitoneum. The uterus was bulky and consistent with 6 weeks of gestation, while the right adnexa appeared normal. The patient had an uneventful postoperative recovery, and the IUP was monitored conservatively. At term, she underwent an emergency lower segment cesarean section and delivered a live female neonate weighing 3130 g, with Apgar scores of 7 and 9 at one and five minutes, respectively. HP, though rare, can follow ovulation induction. The presence of an IUP does not exclude a concomitant ectopic gestation. A high index of suspicion and timely diagnosis are crucial in women presenting with abdominal pain and an adnexal mass. Routine first-trimester ultrasound of the adnexa is essential for early detection. Downloads Downloads Published How to Cite Issue Section License Copyright (c) 2025 Asian Journal of Medical Sciences This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Authors who publish with this journal agree to the following terms: - The journal holds copyright and publishes the work under a Creative Commons CC-BY-NC license that permits use, distribution and reprduction in any medium, provided the original work is properly cited and is not used for commercial purposes. The journal should be recognised as the original publisher of this work. - Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. - Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).