heterotopic pregnancy presenting as maternal acute abdomen at 19 weeks of gestation: a case report

Heterotopic pregnancy is the simultaneous presence of intrauterine and ectopic gestations. it is typically diagnosed in the first trimester via sonography or when patients present with vaginal bleeding or abdominal pain. we report a case of a 26-year-old asian primigravida woman who conceived through ovulation induction and presented at 19 weeks and 4 days of gestation—one week after a successful macdonald cerclage, with severe abdominal pain and hemodynamic instability. bedside ultrasound revealed significant hemoperitoneum and a viable intrauterine fetus. emergency laparotomy identified an unruptured right fallopian tube containing a 5 × 6 cm mass. a right salpingectomy was performed due to suspected ectopic pregnancy, and no other bleeding source was found. histopathology confirmed tubal ectopic pregnancy. the postoperative course was uneventful, and the intrauterine pregnancy successfully progressed to term. heterotopic pregnancy should be considered in the differential diagnosis of hemoperitoneum, even in the second trimester.