Ruptured heterotopic pregnancy presenting with relative bradycardia in a woman not receiving reproductive assistance

Spontaneous Heterotopic Pregnancy With Live Infant: Report Of Two Cases

“…Interestingly however, improved ultrasound technology has not reflected in improved early diagnosis of HP (18). A suspicious adnexal finding on pelvic ultrasound is frequently misdiagnosed as corpus luteum cyst (6). Ultrasound visualisation of cardiac activity in both intrauterine and extrauterine gestations though helpful for diagnosis is very rare (12).…”

Heterotopic Pregnancy Diagnosed by Emergency Ultrasound

“…Yet the frequency of ectopic and heterotopic pregnancies has increased in the last half century due to advancements in reproductive technology and an increasing rate of pelvic inflammatory disease (3)(4)(5)13). The incidence of heterotopic pregnancy in patients assisted by reproductive technology has been reported as between 1:100 and 1:500, and estimates in the general population are between 1:2600 and 1:8000 (5,6,13,14). Other risk factors for ectopic (and likely heterotopic) pregnancy include previous ectopic pregnancy, fallopian tube surgery, treatment with superovulation medication (such as clomiphene citrate), Deithylstilbestrol exposure before birth, and possibly endometriosis and cigarette smoking (14).…”

“…None of these patients had the diagnosis made upon her initial evaluation. Four of the seven patients were thought to have a corpus luteum cyst before shock or repeat ultrasound necessitated laparotomy (6,9,12). Two others had had an elective abortion of the IUP before presenting to the ED with symptoms of the ectopic pregnancy (8,11).…”

“…The emergency physician may be lulled into a false sense of security by the sonographic finding of an intrauterine pregnancy, and must avoid the pitfall of neglecting to closely inspect the adnexa. Even when pelvic ultrasound reveals a suspicious adnexal finding, the erroneous diagnosis of corpus luteal cyst is frequently made (6).…”

An unanticipated case of heterotopic pregnancy

“…Cases have been reported in literature where an erroneous diagnosis of haemorrhagic corpus luteum or ovarian tumour was given to an adnexal mass that was subsequently found to be an ectopic pregnancy. 9,17,18 Acute presentations with an intrauterine pregnancy have been misconstrued as ovarian cyst accident with the pathology subsequently revealing itself either during surgery or in histology specimens. 9,19 A relatively fewer number of cases have been reported in literature of the reverse scenario where the initial presentation was due to the ectopic pregnancy and management focussed on initial stabilisation of the patient and treatment of the ectopic pregnancy and the intrauterine component came to light after the acute event.…”