Spontaneous heterotopic pregnancy: Diagnosis and surgical management

Heterotopic pregnancy is a rare form of pregnancy, defined by the coexistence of an ectopic and an intrauterine pregnancy. The diagnosis of heterotopic pregnancy remains one of the greatest challenges of the gynecological-obstetrical emergencies. We report a rare case of spontaneous heterotopic pregnancy of a 28-year-old woman, diagnosed with a heterotopic pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca. Heterotopic pregnancy is a rare form of pregnancy, defined by the coexistence of an ectopic and an intrauterine pregnancy. The most common functional signs are abdominal pain, vaginal bleeding, pelvic mass and peritoneal irritation. The first-line paraclinical examination is suprapubic and transvaginal pelvic ultrasound. Therapeutic management of heterotopic pregnancies involves rapid intervention on the ectopic pregnancy, while respecting the intrauterine pregnancy if it has progressed, in order to preserve the patient's fertility. Diagnosis of heterotopic pregnancy is often difficult and management should be initiated as soon as possible given the risk of maternal mortality. •Heterotopic pregnancy is the concomitant presence of pregnancies in at least two different implantation sites.•The diagnosis of heterotopic pregnancy should not be delayed by the discovery of an intrauterine gestational sac in symptomatic women,•Prompt diagnosis, management and intervention can help preserve the patient's fertility.