Late presentation of a heterotopic pregnancy at 19 weeks of gestation leading to maternal collapse: A case report

BACKGROUND: Heterotopic pregnancy is a rare form of pregnancy that involves implantation of simultaneous pregnancies at two sites. They are normally identified in early gestation when patients become symptomatic with vaginal bleeding or abdominal pain. CASE PRESENTATION: A 35-year-old woman (para 0, gravida 2) presented to the emergency department in haemorrhagic shock at 19 weeks and 5 days of gestation. On assessment she was hemodynamically unstable and was found to have a large hemoperitoneum on ultrasound. She subsequently underwent an exploratory laparotomy and right salpingectomy for a suspected ectopic pregnancy. The postoperative period was uneventful, and the intrauterine pregnancy continued to term. CONCLUSION: Heterotopic pregnancy should be included in the differential diagnosis for women presenting with hemoperitoneum even beyond the first trimester.