Heterotropic Gestation with Ruptured Ectopic Pregnancy: Exploratory Laparotomy with Total Left Salpingectomy and Subsequent Spontaneous Vaginal Delivery

Abstract

Introduction: Ectopic pregnancy is a frequent gynaecological emergency, particularly in cases of sudden rupture, and remains the primary cause of maternal death during the first trimester, contributing to approximately 10%–15% of all maternal fatalities. Prompt and precise diagnosis is essential to minimise health risks and mortality, as well as to lower the financial burden associated with repeated emergency care, hospitalisation, urgent or extensive surgical interventions, and subsequent assessments or treatments for infertility. Case Summary: A case of heterotopic gestation with a ruptured left tubal ectopic gestation with a co-existing intra-uterine pregnancy in a 29-year-old gravida 2 para 1 (one alive), managed at LAUTECH teaching hospital, Ogbomoso.  She presented with a sudden onset of severe lower abdominal pain, which became generalised, abdominal distension and dizziness following a period of amenorrhea of 8 weeks. She had an exploratory laparotomy on account of a ruptured left tubal ectopic with subsequent spontaneous vaginal delivery of a live fetus at term. Outcome: The patient was managed successfully, had an uneventful postoperative period, vaginal delivery and a follow-up visit. Conclusion: Heterotropic pregnancy is a rare condition, though on the rise due to increased uptake of assisted conception. The ectopic component can be life-threatening and should be borne in mind in any woman presenting with this condition. Emergency laparotomy is recommended for prompt management.