Heterotopic pregnancy with suspicion of superfetation

What is it about?

At 22 days after intrauterine insemination with ovulation induction using clomiphene citrate at a previous hospital, a 30-year-old woman was admitted to our hospital owing to right lower quadrant abdominal pain. We diagnosed threatened abortion because of a gestational sac in the uterus on transvaginal ultrasonography. The next day, she complained of increased abdominal pain. Transvaginal ultrasonography revealed a gestational sac-like structure in the echo free space. She was diagnosed with heterotopic pregnancy due to a ruptured right tubal pregnancy, underwent laparoscopic right salpingectomy. Rupture of a gestational age of 5 weeks is extremely rare. If this was a case of a heterotopic pregnancy due to superfetation, it could be explained as this clinical course. When a pregnant woman develops abdominal pain, heterotopic pregnancies should not be excluded from the differential diagnosis, and the possibility of superfetation should be taken into consideration.

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Why is it important?

When a pregnant woman develops abdominal pain, it is important to not exclude heterotopic pregnancies from the differential diagnosis, even if an intrauterine pregnancy has been confirmed. To accomplish this, it is important that the patient interview is thorough and that sufficient information is obtained. This will lead to a more accurate diagnosis. In particular, careful attention should be paid to patients undergoing fertility treatment and ovulation induction and to those who have undergone embryo transplantation for more than two times. Although such cases are extremely rare, the possibility of superfetation should be taken into consideration, and information about the preceding cycle should be acquired.

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