ABSTRACT
Heterotopic pregnancy is a rare clinical condition characterized by the simultaneous presence of intrauterine
and extrauterine gestations. Although commonly associated with assisted reproductive techniques, it may
also occur spontaneously, with an estimated incidence of 1 in 30,000 pregnancies. Despite advances in
ultrasonographic imaging, diagnosis remains difficult and is often based on the presence of acute abdominal
symptoms.
We present the case of a 35-year-old Gravida 3, Para 2 woman with a prior cesarean section who booked
for antenatal care at 14 weeks’ gestation. An initial ultrasound confirmed a single viable intrauterine
pregnancy; however, a repeat scan at 36 weeks and 4 days revealed a right adnexal mass in the context of
intrauterine fetal demise (IUFD) dated at approximately 16 weeks, leading to a diagnosis of heterotopic
pregnancy.
The patient underwent an elective cesarean section at 38 weeks, resulting in the delivery of a healthy female
neonate. The adnexal mass was excised intraoperatively and submitted for histopathological evaluation.
Postoperative recovery was uneventful.
This case highlights the diagnostic challenges of heterotopic pregnancy following spontaneous conception,
particularly in asymptomatic patients, and is notable for its late detection and successful term delivery. It
highlights the need for sustained clinical suspicion in women with prior pelvic surgery and the importance
of multidisciplinary management to ensure favorable maternal and fetal outcomes. Early imaging and
timely intervention remain critical in optimizing prognosis.
Keywords: Adnexal mass, Caesarean section, Heterotopic pregnancy, Spontaneous conception.
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