A Rare Case of Sequential Contralateral Tubal Pregnancies

Bilateral tubal ectopic pregnancies are the rarest form of extrauterine pregnancy, with an incidence higher in women who are undergoing ovulation induction or assisted reproductive techniques. With an unpredictable clinical course and similar presentation to unilateral ectopic pregnancies, it is important to explore the possibility of bilateral tubal pregnancies with known risk factors. Early recognition is essential to prevent morbidity. We report a case of a 26-year-old gravida 3 para 2 female patient who presented to the emergency department with right lower pelvic pain and vaginal bleeding several weeks after a routine Papanicolaou (Pap) smear. The patient is sexually active, with a history of chlamydia and prior dilation and curettage for a medical abortion in 2023. Although she previously had a negative urine pregnancy test at her obstetrician-gynecologist (OBGYN), repeating testing in the emergency department revealed a positive urine pregnancy test and a serum human chorionic gonadotropin (β-hCG) of 1673.14 mIU/mL, with normal laboratory values. Review of systems is positive for abdominal pain and vaginal bleeding, and her physical exam is unremarkable with a soft, nontender, nondistended abdomen. The patient is discharged with resolved symptoms and a positive pregnancy test, with instructions to follow up with her OBGYN. Two days later, the patient returned for repeat testing, demonstrating a β-hCG 1795.46 mIU/mL, with a transvaginal ultrasound recording an ovoid structure adjacent to the right adnexa measuring 2.4 x 2.2 x 2.0 cm. Concern for ectopic pregnancy was raised given the