WHEN RARITY MEETS REALITY- A CASE OF OVARIAN HETEROTOPIC PREGNANCY IN EARLY GESTATION.

Abstract

Background: Heterotopic pregnancy is the coexistence of an extrauterine gestation with an intrauterine gestation. Its incidence has increased with the increasing use of assisted reproductive techniques. Ovarian heterotopic pregnancy is exceptionally uncommon and often presents a diagnostic challenge, as the presence of an intrauterine pregnancy often masks a concurrent ectopic pathology. This report aims to highlight the importance of early diagnosis and prompt management for this kind of a rare entity.

Results: A 22-year-old primigravida presented at 9 weeks gestation with lower abdominal pain and vaginal spotting. She had conceived following ovulation induction. On clinical examination, left iliac fossa tenderness, guarding, and cervical motion tenderness were noted. Ultrasonographic examination revealed a live intrauterine gestation and a simultaneous live ectopic pregnancy within a heterogeneous left adnexal mass, with the left ovary not separately visualized. Emergency exploratory laparotomy revealed 150–200 mL of hemoperitoneum and a ruptured left ovarian ectopic pregnancy. A left Salpingo-oophorectomy was performed. Suction evacuation of the intrauterine pregnancy was done following intraoperative counselling in view of risk to the intrauterine conceptus. Histopathology confirmed the diagnosis.

Conclusion: Ovarian heterotopic pregnancy, though rare, must be considered in early pregnancy with adnexal masses, especially following ovulation induction. The presence of an intrauterine gestation should not preclude thorough adnexal assessment. Early diagnosis and timely surgical intervention are critical to prevent maternal morbidity and ensure optimal outcomes.