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West Florida


Brandon Regional Hospital


Emergency Medicine

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Heterotopic Pregnancy, Ectopic, Pregnancy


Emergency Medicine | Female Urogenital Diseases and Pregnancy Complications | Obstetrics and Gynecology | Reproductive and Urinary Physiology


  • Heterotopic pregnancy occurs in about 1 in 30,000 naturally conceived pregnancies (5). The risk rises 1-3% for pregnancies occurring through assisted reproductive technologies (ART) (1).
  • Isolated ectopic pregnancy affects an average of 1 in every 150 live births (1).
  • A known pre-existing intrauterine pregnancy (IUP) can be falsely reassuring and delay the diagnosis of a potentially life-threatening concurrent ectopic pregnancy.
  • Presentation is vague and 45% of patients have no symptoms (5).
  • Differential Diagnoses: endometritis, incomplete miscarriage, ruptured ovarian cyst, non-GYN cause (ie: appendicitis or UTI).
  • Risk Factors: Infertility treatment, in vitro fertilization (IVF), prior ectopic, prior tubal surgery, use of IUD, smoking (1).
  • These patients are more likely to have spontaneous or medically induced abortions, and are 30% less likely to have live-birth delivery.
  • Laparoscopy or laparotomy are standard of care. They carry a 58-70% success rate of parturition for the IUP (1).

The Evil Twin: The Case of Heterotopic Pregnancy



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