Sextuplet heterotopic pregnancy presenting as ovarian hyperstimulation syndrome and hemoperitoneum

Objective To describe a case of bilateral ruptured heterotopic pregnancies presenting as persistent ovarian hyperstimulation syndrome in a quadruplet pregnancy. Design Case report. Setting University hospital and clinic. Patient(s) An infertile patient who conceived using gonadotropin therapy. Intervention(s) Culdocentesis with resultant aspiration of sanguinous fluid prompted laparoscopic exploration and bilateral salpingectomies. Main Outcome Measure(s) Not applicable. Result(s) Gross hemoperitoneum and ruptured bilateral heterotopic sextuplet pregnancy. Conclusion(s) Patients who conceive after gonadotropin therapy should be closely monitored during treatment and in early pregnancy to recognize and minimize morbidity and complications. After superovulation, the presence of an intrauterine pregnancy, either single or multiple, does not rule out the possibility of ectopic pregnancy, and this should always be considered as a possibility in the setting of acute anemia.