Spontantaneously Conceived Heterotropic Pregnancy in a Lady with Recurrent Pregnancy Loss-Diagnostic Dilemma and Management

Heterotropic pregnancy is characterised by an ectopic gestation existing with an intrauterine pregnancy. It is rare in a spontaneous conception, with incidence increasing with advent of artificial reproductive techniques. The diagnosis remains challenging, with symptoms presenting as complications of first trimester pregnancy, and early ultrasound imaging may be inconclusive. Hence, it requires high clinical suspicion and timely intervention to avoid serious complications. We present a case of naturally conceived heterotopic pregnancy in a lady with previous two abortions, with autoimmune disease. On initial presentation, the case was diagnosed as an intrauterine pregnancy with corpus luteal cyst rupture. On subsequent presentation, diagnosis of heterotropic pregnancy with ruptured ectopic was made. The patient was managed by emergency laparotomy. Post surgery, patient carried her intrauterine pregnancy well, successfully delivering a healthy baby at term. The case highlights the need for clinical suspicion, supported with imaging modalities and timely management for a favorable outcome.