Spontaneous heterotopic pregnancy. Case Report

Abstract

Introduction: a heterotopic pregnancy presents an intrauterine and an extra-uterine gestation. The problem arises when one pregnancy cannot develop outside the uterus, which can lead to severe complications and even death. The specific selection of this case report is motivated by daily practice, where timely action allows us to save the lives of pregnant women who are susceptible to this condition.

Clinical case: This is the case of a 33-year-old pregnant woman who presented to the emergency department of the Pablo Jaramillo Crespo Foundation Hospital in Cuenca, at 9 weeks' gestation of her second pregnancy. The patient presented with severe abdominal pain and vaginal bleeding. Ultrasound findings revealed a trabeculated isoechoic mass in the right ovary, as well as a viable fetus in the uterine cavity. The diagnosis was resolved by laparotomy, revealing a heterotopic pregnancy in the right adnexa; the intrauterine pregnancy was viable and reached term without complications.

Conclusion: in the present clinical case, reaching the correct diagnosis was very complex due to the low incidence. The imaging study was performed appropriately, despite the fact that it was operator-dependent. The surgical resolution path was taken in accordance with the capabilities and limitations of the surgical team. Once the acute extra-uterine pathology was detected and resolved, the intrauterine pregnancy came to term.