Bilateral Simultaneous Tubal Ectopic Pregnancy with a Third Intrauterine Pregnancy: A Rare Case of Heterotopic Pregnancy

Abstract

Abstract

Background:

Bilateral tubal ectopic pregnancies are rare; if associated with intrauterine pregnancy, these ectopic pregnancies are extremely rare. Urgent management of this extremely rare pregnancy is vital because of the associated morbidity and mortality. The appropriate fertility-preserving surgery must also be considered.

Case:

A 23-year-old primigravida was diagnosed with simultaneous bilateral tubal ectopic pregnancies and an intrauterine pregnancy following induction of ovulation with clomiphene citrate. At laparotomy, the diagnosis of a ruptured left tubal ectopic pregnancy and an unruptured right tubal ectopic pregnancy with a coexisting single viable intrauterine pregnancy were confirmed. The case was managed with a left salpingectomy and a right salpingotomy. After 48 hours, suction evacuation was performed for the incomplete abortion of the third intrauterine pregnancy that developed after the surgery.

Results:

This patient was discharged uneventfully on the fifth postoperative day. After 3 weeks, she was found to be good with nonpredictable serum β-human chorionic gonadotropin.

Conclusions:

All gynecologists should be aware of heterotopic and other rare types of ectopic pregnancies when assessing any case of early pregnancy to ensure early diagnosis and early proper management.