Spontaneous uterine cornual rupture at 26 weeks' gestation in an interstitial heterotopic pregnancy following in vitro fertilization

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This is a very unusual presentation of a twin pregnancy following IVF. One baby implanted normally inside the uterus and one implanted in the very first portion (interstitial) of the Fallopian tube as it leaves the uterus. Most of these pregnancies rupture the tube early into the pregnancy. This one made it to the second trimester. Even at Cesarean the diagnosis was not completely clear. On review of the early sonograms and the operative notes it became obvious that this was a twin pregnancy that had implanted in two areas and the uterine septation (separation) that were seen both on late sono and at delivery were, in fact, the uterine wall covering the interstitial component of the tube.

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