Heterotopic pregnancy refers to the coexistence of both intrauterine and ectopic pregnancies.
Risk factors:
(1) in vitro fertilization
(2) history of ectopic pregnancy or abortion
(3) ovarian hyperstimulation syndrome
The most common site for the ectopic pregnancy is in the fallopian tube but can occur at other sites. More than one fetus may be present at each site.
Presentation:
(1) intrauterine gestational sac on ultrasonography
(2) abdominal pain
(3) evidence of ectopic rupture
(4) variable uterine bleeding
The patient may present with abdominal pain days or weeks after an abortion.
When examining a woman with an intrauterine pregnancy on ultrasonography it is important to scan for a possible ectopic as well, especially if the woman has had in vitro fertilization.
If the intrauterine pregnancy is to be preserved, then surgery is required on the ectopic.
