Vanishing twin syndrome and chronic ruptured ectopic pregnancy in the setting of triplet heterotopic pregnancy

Introduction: The objective of this article is to present a case of a concurrent chronic ruptured ectopic pregnancy (CEP) and vanishing twin syndrome (VTS) in the setting of a naturally conceived heterotopic triplet pregnancy. Case Report: A 31-year-old multiparous female presented with abdominal pain, vaginal bleeding, VTS, and an indeterminate mass in the posterior cul-de-sac. The diagnosis of a rare triplet heterotopic pregnancy (HP) was made during laparoscopy in the setting of VTS and CEP. The patient underwent laparoscopic left salpingectomy, and the remaining viable intrauterine pregnancy progressed to term vaginal delivery. Conclusion: This case highlights the danger of relying on probability to rule out medical diagnoses and brevity of medical literature on CEP. Two intrauterine gestational sacs delayed arrival at the correct diagnosis of ectopic pregnancy due to the rarity of HP. In addition, providers did not recognize the classic signs of CEP: prolonged intermittent pelvic pain, vaginal bleeding, and an amorphous, avascular pelvic mass. Additional information regarding CEP should be included in common medical educational resources to better inform patient care.