A 32-year-old woman who developed a ruptured ectopic pregnancy while carrying a viable pregnancy in the uterus has been successfully treated by doctors at Artemis Hospital, Gurugram. The rare complication occurred following in-vitro fertilisation (IVF).
The patient was 11 weeks pregnant when doctors diagnosed heterotopic pregnancy, a condition in which an ectopic pregnancy develops alongside an intrauterine pregnancy.
The ectopic pregnancy had ruptured, causing nearly 800 ml of blood and clots to collect inside the abdomen. The patient required immediate surgery.
Doctors performed emergency laparoscopic surgery to remove the ruptured right fallopian tube and clear the blood and clots from the abdominal cavity. The intrauterine pregnancy was preserved.
The procedure was particularly challenging because the patient also had endometriosis. Adhesions caused by the condition had concealed the fallopian tube and ovary behind the uterus, making it difficult for the surgical team to access the affected area.
The doctors carefully removed the ruptured tube, controlled the bleeding and avoided unnecessary handling of the uterus to reduce any risk to the ongoing pregnancy.
“The primary challenge in a heterotopic pregnancy is to manage the ectopic pregnancy while preserving the ongoing intrauterine pregnancy,” Dr Renu Sehgal, chairperson of the Department of Obstetrics and Gynaecology at Artemis Hospital, Gurugram, said.
The timing of the complication added to the complexity of the case. At 11 weeks, the uterus is already enlarged and the tubal pregnancy is more developed.
“Once the tubal pregnancy ruptures, bleeding can be torrential and immediate surgical intervention becomes necessary,” Sehgal said, adding that the endometriosis-related adhesions had made it more difficult to identify the affected tube and perform the surgery.
The patient’s postoperative recovery was uneventful. She was mobilised after surgery, her catheter was removed on the first postoperative day and she was discharged in stable condition. Regular follow-up and ultrasound examinations were recommended to monitor the ongoing pregnancy.
Heterotopic pregnancy is rare, occurring in about one in 30,000 pregnancies in the general population. The risk is considerably higher following assisted reproductive techniques such as IVF.
Doctors also highlighted the importance of early evaluation, particularly between six and eight weeks of pregnancy, when both the uterus and an ectopic pregnancy are smaller and treatment may be comparatively easier.
Why Early Detection Matters
Heterotopic pregnancy can be challenging to recognise because seeing a pregnancy inside the uterus may lead to the assumption that an ectopic pregnancy has been ruled out. However, an intrauterine pregnancy does not eliminate the possibility of a simultaneous ectopic pregnancy, especially after IVF.
The successful treatment highlights the importance of maintaining a high level of clinical suspicion and acting promptly when symptoms suggest a possible ectopic pregnancy, even when an intrauterine pregnancy has already been confirmed.