Heterotopic Pregnancy Presenting as Maternal Acute Abdomen at 19 Weeks of Gestation: A Case Report

Heterotopic pregnancy is the simultaneous presence of intrauterine and ectopicgestations. It is typically diagnosed in the first trimester via sonography or when patientspresent with vaginal bleeding or abdominal pain. We report a case of a 26-year-oldAsian primigravida woman who conceived through ovulation induction and presentedat 19 weeks and 4 days of gestation—one week after a successful Macdonald cerclage,with severe abdominal pain and hemodynamic instability. Bedside ultrasoundrevealed significant hemoperitoneum and a viable intrauterine fetus. Emergencylaparotomy identified an unruptured right fallopian tube containing a 5 × 6 cm mass.A right salpingectomy was performed due to suspected ectopic pregnancy, and noother bleeding source was found. Histopathology confirmed tubal ectopic pregnancy.The postoperative course was uneventful, and the intrauterine pregnancy successfullyprogressed to term. Heterotopic pregnancy should be considered in the differentialdiagnosis of hemoperitoneum, even in the second trimester.