Heterotopic Triplet Pregnancy: A Case Report

Heterotopic pregnancy, the coexistence of intrauterine and ectopic gestations, is rare in spontaneous conceptions but more common with ovulation induction and assisted reproductive techniques.Its diagnosis is often delayed because finding an intrauterine pregnancy can falsely reassure clinicians, and a missed ectopic component can cause life-threatening rupture.A 34-year-old woman (gravida 2, para 1, with a prior cesarean section) who conceived after clomiphene citrate ovulation induction presented at six weeks of gestation with syncope, abdominal pain, and hemodynamic instability.Ultrasound showed an intrauterine twin gestation with free pelvic fluid.Laparoscopy confirmed a ruptured right tubal ectopic pregnancy with hemoperitoneum, treated by right salpingectomy.One intrauterine twin later vanished, and the pregnancy otherwise continued to term, ending in the cesarean delivery of a healthy infant.This case shows that a confirmed intrauterine pregnancy does not exclude an ectopic one.Clinicians should maintain a high index of suspicion for heterotopic pregnancy in any woman who has undergone ovulation induction and presents with pain or instability, since early recognition allows life-saving surgery while preserving the intrauterine pregnancy.