The Evil Twin: The Case of Heterotopic Pregnancy

<p> <ul> <li> Heterotopic pregnancy occurs in about 1 in 30,000 naturally conceived pregnancies (5). The risk rises 1-3% for pregnancies occurring through assisted reproductive technologies (ART) (1). </li> <li> Isolated ectopic pregnancy affects an average of 1 in every 150 live births (1). </li> <li> A known pre-existing intrauterine pregnancy (IUP) can be falsely reassuring and delay the diagnosis of a potentially life-threatening concurrent ectopic pregnancy. </li> <li> Presentation is vague and 45% of patients have no symptoms (5). </li> <li> Differential Diagnoses: endometritis, incomplete miscarriage, ruptured ovarian cyst, non-GYN cause (ie: appendicitis or UTI). </li> <li> Risk Factors: Infertility treatment, in vitro fertilization (IVF), prior ectopic, prior tubal surgery, use of IUD, smoking (1). </li> <li> These patients are more likely to have spontaneous or medically induced abortions, and are 30% less likely to have live-birth delivery. </li> <li> Laparoscopy or laparotomy are standard of care. They carry a 58-70% success rate of parturition for the IUP (1). </li> </ul></p>