A rare case of triplet heterotopic pregnancy-A case report

Abstract

Triplet heterotopic pregnancy refers to the presence of specifically 3 concurrent gestations with at least 1 being abnormally implanted. Heterotopic pregnancy is rare and estimated to occur in about 1 per 30,000 spontaneous pregnancies while a higher prevalence may occur in assisted reproduction techniques that may reach up to 1 case per 100 in some literatures. The triplet heterotopic pregnancies are often in association with risk factors, as tubal factor infertility, pelvic infections, in vitro fertilization, more embryos transfer, and use of pharmacologic ovulation induction. A 22-year-old primigravida with history of undergoing ovulation induction treatment with 2 &12 months of amenorrhea was brought to the Emergency Department with complaints of pain abdomen, vomiting and generalized weakness since one day. Transvaginal ultrasound revealed a single live intrauterine gestation at 9 weeks 3 days with fetal cardiac activity alongwith a well defined round to oval anechoic lesion likely gestation sac within the left fallopian tube with moderate to gross hemoperitoneum leading to the diagnosis of a heterotopic pregnancy with left ruptured ectopic pregnancy. She underwent an Exploratory Laparotomy under general anesthesia and was found to have a left sided ruptured tubal ectopic at the isthmo-ampullary junction measuring about 4 x 5 cms for which salpingectomy was done along with an incidental finding of a right sided unruptured ectopic pregnancy in the ampullary region which was in the process of tubal abortion for which right salpingotomy was done. Hemoperitoneum of 900 ml was present. Serial USG monitoring and regular antenatal check ups were done for intrauterine pregnancy and patient was followed up till term. She was admitted at 38 weeks gestation and delivered a healthy, term male baby of birth weight 2.86 kgs through caesarean section.