A rare case of spontaneous heterotopic pregnancy with intrauterine gestational trophoblastic neoplasia and tubal ectopic pregnancy at a remote secondary care hospital

A simultaneous presence of intrauterine and extrauterine gestation is called as heterotopic pregnancy (HP). The incidence of spontaneous HP is 1: 30000, which is very rare. In this case report, we are reporting a rare case of spontaneous HP in a 40-year-old lady with intrauterine gestational trophoblastic neoplasia (GTN) and ruptured tubal ectopic pregnancy in a remotely located secondary care hospital. The lesson learnt from our case report is that detection of intrauterine gestation does not rule out the possibility of the presence of ectopic pregnancy. Also, HP can occur without any obvious risk factors like in our case. It should be always kept in mind that HP can occur in any woman of reproductive age group. In the end, our patient was fortunate that she presented to us in a stable haemodynamic condition in spite of having ruptured tubal ectopic with spontaneous stoppage of bleeding from the ruptured tube. Hence, to achieve a great chance of favourable obstetric outcome, all treating doctors including family physicians should have a high index of suspicion to have accuracy in early diagnosis and treatment of a various variety of HP as these can occur with or without predisposing risk factors.