Behind the mystery, “rare” until that happens to you. A unique presentation; hard to suspect

  • Shama Bashir Assistant Professor Gynae/Obs
  • Aqsa Ikram-Ul-Haq Assistant Professor Gynae/Obs
  • Nadia Sadiq
  • Tallat Farkhanda
  • Umm-e-Aqsa Postgraduate trainee Gynae/Obs
  • Saliha Postgraduate trainee Gynae/Obs


This report investigates into the complexities of heterotopic pregnancy, a rare and potentially life-threatening condition characterized by simultaneous intrauterine and extra-uterine pregnancies. Diagnosis is challenging, requiring a vigilant approach, particularly in cases with risk factors or acute symptoms. The incidence of this condition has increased with the use of assisted reproductive techniques (ART), and delayed diagnosis can result in greater health risks.

In a specific case, a 33-year-old Asian woman presented with abdominal pain during her 17-week intrauterine pregnancy, which later escalated with heavy bleeding. Suspecting heterotopic pregnancy, the medical team performed an emergency laparotomy to successfully manage the situation.

Discussion highlights the diagnostic complexities of heterotopic pregnancy, often masquerading as an ectopic pregnancy. Beta-hCG levels can be misleading, making transvaginal ultrasound a critical diagnostic tool. The report emphasizes the role of ART and other risk factors in the condition's rising prevalence, while underscoring the importance of preserving the intrauterine pregnancy during management.

In conclusion, clinicians must maintain a heightened awareness of heterotopic pregnancy in patients with abdominal pain, especially when presenting symptoms resemble ectopic pregnancy. Timely diagnosis and appropriate management are essential for better patient outcomes, and routine screening to rule out extrauterine gestation is imperative.

Case Report