Spontaneous heterotopic pregnancy with progression to miscarriage and tubal rupture

Abstract

Objective: To report the case of a multiparous patient who developed a tubal pregnancy rupture after undergoing uterine curettage for ongoing abortion in the context of spontaneous heterotopic pregnancy. Case details: A 35-year-old multiparous patient was admitted to the emergency department complaining of vaginal bleeding and pelvic pain, associated with a positive pregnancy test. Initial evaluation showed detectable levels of β-hCG and ultrasound examination suggestive of incomplete abortion, concomitant with the presence of a right adnexal mass of undetermined etiology. It was decided to perform uterine curettage. During the post-procedure clinical observation period, the patient developed severe anemia and a paradoxical elevation of serum β-hCG levels, while maintaining hemodynamic stability. A new ultrasound revealed a large amount of free intraperitoneal fluid and an adnexal mass compatible with a ruptured ectopic pregnancy. She underwent exploratory laparotomy with right salpingectomy and blood transfusion, presenting satisfactory postoperative evolution. The anatomopathological examination confirmed a ruptured tubal pregnancy associated with uterine trophoblastic remains. Final considerations: This case highlights the diagnostic challenges of spontaneous heterotopic pregnancy and reinforces the need for high clinical suspicion and systematic adnexal evaluation, even in the presence of an apparent diagnosis of abortion.