Heterotopic pregnancy with ovarian ectopic gestation

Heterotopic pregnancy (HTP) is the simultaneous occurrence of intrauterine and extrauterine pregnancies and remains a diagnostic and therapeutic challenge – especially following assisted reproductive techniques. We report a 20-year-old woman (gravida 3, para 1, abortion 1) who presented at 6.6 weeks’ gestation with abdominal pain, vaginal bleeding, nausea, vomiting, and lower back pain. Transvaginal ultrasound and clinical assessment identified a left-sided ovarian ectopic pregnancy with ongoing intra-abdominal bleeding. Emergency exploratory laparotomy and left oophorectomy were performed, with hemostasis and drain placement. Post-operative recovery was uneventful; follow-up transvaginal ultrasound showed no residual abnormality, and the patient was discharged in stable condition. This case underscores the importance of maintaining a high index of suspicion for HTP – even when an intrauterine pregnancy is present – and highlights the role of careful transvaginal sonography, timely surgical management in hemorrhagic presentations, and multidisciplinary perioperative care. Early recognition and prompt intervention are essential to prevent life-threatening complications and to optimize maternal and residual intrauterine pregnancy outcomes when applicable.