Spontaneous heterotopic pregnancy presenting with tubal rupture Spontaneous heterotopic pregnancy presenting with tubal rupture

Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. There are many variables in heterotopic pregnancy which makes the diagnosis of ectopic pregnancy a very challenging task. Nearly 85% of these cases go undiagnosed until there is rupture of the ectopic pregnancy that accompanies the intrauterine pregnancy. Though the presence of an intrauterine gestation reliably excludes the possibility of an ectopic gestation, it does not rule out a heterotopic pregnancy. So a rigorous sonographic examination of the adnexae and cul de sac is required even in the presence of an intrauterine gestation. Every clinician, who is treating women in reproductive age group, should keep this clinical catastrophe in mind for accurate and early diagnosis so as to do timely intervention which can decrease maternal morbidity and mortality. We present a rare case of heterotropic pregnancy after natural conception that was misdiagnosed to be a twin pregnancy until she presented with haemoperitoneum from ruptured tubal pregnancy.