EP14.25: A case report of spontaneous triplet heterotopic pregnancy

Heterotopic pregnancy is the coexistence of intra- and extrauterine pregnancies with a spontaneous incidence of 1 in 30,000 and increases with artificial reproductive techniques and previous tubal damage. Ectopic pregnancies are 97% tubal but 1 in 3600 cases involve the interstitial area. Half of these are detected late, presenting with signs of rupture, therefore, extremely life-threatening. This is a case of a 25-year-old low-risk, asymptomatic, primigravid who initially presented with a single intrauterine gestational sac, but, with serial ultrasound, later found to have heterotopic triplet anembryonic pregnancy. Three-dimensional ultrasound showed three distinct, separate and well-decidualised empty gestational sacs, with two at interstitial locations, five to six weeks gestational age. The ovaries showed multiple corpora lutea with elevated human chorionic gonadotropin. The patient was managed with a single dose intramuscular methotrexate which resulted in passage of the intrauterine pregnancy five days post-treatment. The case was followed up until the 298th day where repeated scans showed persistence and minimal decrease in size of the interstitial gestational sacs. Transvaginal sonography remains the first line examination for the visualization of the products of conception. Comprehensive evaluation of the uterus, cervix, ovaries, fallopian tubes and the urinary bladder despite confirmation of an intrauterine pregnancy even in the low-risk population is of utmost importance. A high index of suspicion with systematic and repeated sonographic assessment of the pelvic area aided in the early diagnosis and prompt management of this case. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.