Heterotopic Pregnancy with Intrauterine Quadruplets




Hoang, Christine
Douglas, Elizabeth


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Background: Abdominal pain is a common complaint during pregnancy but it does require thorough evaluation. One in 500-700 pregnancies is complicated by non-obstetric abdominal emergencies, and one in 50 pregnancies is ectopic. In cases of in vitro fertilization (IVF), ectopic implantation may be as high as one in 12 pregnancies. A heterotopic pregnancy is the coexistence of intrauterine and extrauterine gestations at two or more implantation sites, the incidence of which can be as high as one in 50,000 natural pregnancies in certain populations. In cases of IVF, heterotopic pregnancies are as common as 1 in 100. Case information: A G2P1001 34-year-old female presents to the emergency room with 8-10/10 abdominal pain. The pain began in the right lower quadrant and flank but progressed to the entire abdomen. The patient reports of pain with inspiration, right shoulder pain, and nausea. The patient's medical history includes current pregnancy with quadruplets after IVF 6 weeks prior. Physical exam shows a well-nourished female in no apparent distress with diffuse abdominal tenderness, positive rebound, and guarding. Vital signs are within normal limits. Laparoscopic evaluation shows hemoperitoneum, enlarged uterus, and enlarged right fallopian tube. Treatment included laparoscopic salpingectomy without complications. Conclusion: While the possibility of ectopic or heterotopic pregnancies can be easily overlooked, early diagnosis, evaluation, and treatment are imperative. Suspicion should be high for ectopic implantation, particularly in assisted pregnancies, and even with intrauterine gestations.