Diagnostic Challenges Associated with Heterotopic Pregnancy – A Case Report

Heterotopic pregnancy, the simultaneous co-existence of an intrauterine and an extrauterine (ectopic) pregnancy is a very rare occurrence. However, it poses great diagnostic and management challenges. We present a 35-year-old P3+1 (3 alive) lady who was referred from a private facility following nine-weeks history of amenorrhea and a one-day history of lower abdominal pain. She had two different ultrasound scans which suspected an ectopic and an intrauterine pregnancy respectively. She subsequently had laparotomy with finding of haemoperitoneum of 2.5litres and a ruptured right ectopic pregnancy around the isthmic region. Heterotopic pregnancy still remains a diagnostic challenge despite the availability of ultrasound. A high index of suspicion is needed for timely diagnosis and subsequent surgical management for a favorable outcome.