A case report of spontaneous heterotopic pregnancy with ectopic pregnancy in isthmus region with the end of child birth

Heterotopic pregnancy means the coexistence of an intrauterine pregnancy and an ectopic pregnancy. Its incidence is 1 in 30,000 pregnancies. In this study, we report a heterotopic pregnancy with ectopic pregnancy and having heart rate in isthmus region of fallopian tube.

The patient was a 31-years-old woman who had referred to Mobini hospital of Sabzevar city in 2/4/2020 with menstruation delay for 2 weeks and abdominal pain in the hypogastric area with a constant and progressive nature that started about 3 days before the visit. Last menstruation period was 6 weeks and 3 days ago. She had no history of underlying disease or special drug use, and vital signs were stable. She had nausea before visiting and 2 episodes of vomiting in the emergency room of the hospital. In abdominal examination, there was optional guarding and suprapubic tenderness and rebound tenderness. Transvaginal ultrasound and beta titration was performed. In the ultrasound, an echo free focus was seen in the left adnexa with a diameter of 7 mm equivalent to 5 weeks and two days, separately from the ovary, along with a 25×35 mm hematoma around it; which contained the heartbeat of the fetus. A gestational sac with a diameter of 15 mm containing the yolk sac and heartbeat was seen in the endometrial cavity. The patient was transferred to the operating room with the diagnosis of heterotopic pregnancy. The left tube contained a mass of 2×4 cm in the isthmus area, which was completely damaged and was actively bleeding. A left salpingectomy was performed. The intrauterine pregnancy was preserved. The patient referred with labor pain on 6/31/2019 and underwent NVD.

Heterotopic pregnancy mostly occurs in the cases of using assisted reproductive methods. Spontaneous cases of heterotopic pregnancy are rare. Rapid and timely diagnosis plays an essential role in the treatment approach.