Abstract
Sonography is a quick, easy, and inexpensive medical test to determine the etiology of pain in a first-trimester pregnancy. Occasionally, sonograms of early pregnancies do not give an accurate picture, and ectopic pregnancies are missed. Some of the reasons for missed ectopics may include time constraints, staff shortages, poor patient history, misleading textbook information, or orders for a limited examination. A limited examination may comprise only a transvaginal sonogram, and a transabdominal sonogram is not performed. Limited examinations minimize exploration of the area outside the uterus. Sometimes, when an intrauterine gestation is found, the sonogram is considered completed, and a report of an intrauterine pregnancy is given. Investigation of the area outside the uterus is not performed, and the chances of a missed ectopic increases. This case study addresses the occurrence of a heterotopic multifetal gestation. This is an intrauterine gestation combined with an ectopic gestation, sometimes referred to as a combined pregnancy.