II. Definitions

  1. Heterotopic Pregnancy (Compound Ectopic Pregnancy)
    1. Simultaneous ectopic AND intrauterine pregnancy

III. Epidemiology

  1. Associated with Assisted Reproductive Technologies (Infertility Treatment) in up to 1-3% of pregnancies
  2. Rare in spontaneous (non-ART) pregnancy: 1 in 30,000 pregnancies

IV. Labs

  1. See Ectopic Pregnancy
  2. Quantitative bhCG
    1. May be misleading due to normal increases with the intrauterine pregnancy

V. Imaging: Ultrasound

  1. Identification of intrauterine pregnancy does not exclude Ectopic Pregnancy
  2. Ultrasound the Pelvis and Adnexa in addition to intrauterine cavity

VI. Management

  1. See Ectopic Pregnancy
  2. Consult obstetrics
  3. Emergent surgery indications
    1. FAST Exam positive for intraabdominal free fluid
    2. Hemodynamic instability
    3. Significant exam findings (e.g. significant Abdominal Pain)

VII. References

  1. Gallo, Suyama and Snook (2020) Crit Dec Emerg Med 34(10): 3-7

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