Heterotopic pregnancy: diagnostic challenges and management of ruptured ectopic pregnancies in the presence of a viable intrauterine pregnancy

Heterotopic pregnancy (HP), the simultaneous occurrence of intrauterine and ectopic pregnancies, is a rare but potentially life-threatening condition. It poses diagnostic and management challenges, especially in natural conception cycles. We report two cases of heterotopic pregnancies, highlighting the clinical presentation, diagnostic approach, and therapeutic management. These cases underscore the importance of maintaining a high index of suspicion for HP in patients presenting with pelvic pain or abnormal bleeding, even with confirmed intrauterine pregnancy.