Fortified Pregnancy: A Case Report of Heterotopic Gestation with A Successful Obstetrical Outcome

Abstract

Heterotopic pregnancy is a rare condition when at least two pregnancies are present simultaneously at different implantation sites. Such cases may lead to devastating outcomes if nor properly handled. The index patient is a 38 year old Gravida 6 Para 4 (4014), who presented with severe hypogastric pain, pallor, amenorrhea with positive pregnancy test and a transvaginal ultrasound showing a strong consideration of heterotopic gestation. Emergency exploratory laparotomy for ruptured tubal pregnancy, Left salpingectomy, and evacuation of hemoperitoneum was done, with a bulbously enlarged left fallopian tube with a 2-cm point of rupture seen intraoperatively. The procedure was well tolerated and postoperative course was generally uneventful. Repeat transvaginal ultrasound on hospital day three prior to discharge revealed a live intrauterine gestation at 10 weeks and 1 day. At 38 weeks and 1 day age of gestation, the patient delivered vaginally to a term, live, baby boy in cephalic presentation, birth weight of 3600 grams, APGAR score of 8, 9 followed by postpartum intrauterine device insertion. The patient was eventually discharged on hospital day 2 without fetomaternal complications. In conclusion, a successful intrauterine pregnancy with a ruptured heterotopic gestation who underwent surgical intervention though rare is a great possibility. Still, high index of suspicion, complete history and physical examination, sonographic findings in the light of a pregnancy test positive are all imperative to its diagnosis and appropriate management.