Heterotopic pregnancy at Komfo Anokye Teaching Hospital: a case report.
Rex Mawuli Kwadjo Djokoto, Brago Afrifa Sarpong, Edward Anabila Agana et al.
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Case in brief
A 34-year-old woman presented after two months of amenorrhoea with acute abdominal pain and haemorrhagic shock. Bedside ultrasound showed a live 8-week intrauterine pregnancy as well as a left adnexal mass and pelvic free fluid. Emergency laparotomy found approximately 1.28 L of hemoperitoneum and a ruptured left isthmic ectopic pregnancy, treated by total salpingectomy. The intrauterine pregnancy remained viable; postoperative progesterone support was given, and serial beta-hCG levels declined. The pregnancy progressed to 38 weeks, ending in delivery of a live female infant weighing 2.5 kg.
What made this case unusual
The confirmed live intrauterine pregnancy did not exclude a concurrent ruptured ectopic pregnancy, despite the patient presenting in haemorrhagic shock.
Diagnostic / clinical pearl
In a pregnant patient with acute abdominal pain, identifying an intrauterine gestation should not end assessment for an ectopic component; this case had both an intrauterine pregnancy and a ruptured adnexal pregnancy.