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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Related Studies

Ontology: Pregnancy, Heterotopic (C0269291)

Definition (MSH) MULTIPLE PREGNANCY with EMBRYO IMPLANTATION occuring at different locations, involving both an intrauterine site and an extrauterine (ECTOPIC PREGNANCY) site.
Concepts Pathologic Function (T046)
MSH D063192
SnomedCT 31601007
Dutch heterotopische zwangerschap
Portuguese Gravidez heterotópica, Gravidez Heterotópica
Spanish Embarazo heterotópico, Embarazo Heterotópico, embarazo combinado (trastorno), embarazo combinado, embarazos intrauterino Y extrauterino simultáneos, embarazos intrauterino y extrauterino simultáneos
English ectopic pregnancy with intrauterine pregnancy (diagnosis), heterotypic ectopic pregnancy (diagnosis), heterotypic ectopic pregnancy, ectopic pregnancy with intrauterine pregnancy, heterotopic pregnancy, pregnancy heterotopic, Pregnancy, Heterotopic, Pregnancies, Heterotopic, Heterotopic Pregnancies, Heterotopic Pregnancy, Pregnancy, Heterotopic [Disease/Finding], Combined pregnancy, Combined heterotopic pregnancy, Compound ectopic, Combined pregnancy (disorder), Heterotopic pregnancy, Simultaneous intrauterine AND extrauterine pregnancies, Simultaneous intrauterine and extrauterine pregnancies, Pregnancy, combined
Czech Heterotopické těhotenství, heterotopní gravidita, heterotopické těhotenství
Hungarian Heterotop terhesség
Japanese 子宮内外同時妊娠, シキュウナイガイドウジニンシン
French Grossesse hétérotopique
German Heterotope Schwangerschaft, Schwangerschaft, heterotope, heterotope Schwangerschaft
Italian Gravidanza eterotopica
Polish Ciąża heterotopowa
Russian ТРУБНАЯ ГЕТЕРОТОПИЧЕСКАЯ БЕРЕМЕННОСТЬ, ГЕТЕРОТОПИЧЕСКАЯ БЕРЕМЕННОСТЬ В РУДИМЕНТАРНОМ РОГЕ МАТКИ, TRUBNAIA GETEROTOPICHESKAIA BEREMENNOST', БЕРЕМЕННОСТЬ ГЕТЕРОТОПИЧЕСКАЯ, GETEROTOPICHESKAIA BEREMENNOST', GETEROTOPICHESKAIA BEREMENNOST' V RUDIMENTARNOM ROGE MATKI, BEREMENNOST' GETEROTOPICHESKAIA, ГЕТЕРОТОПИЧЕСКАЯ БЕРЕМЕННОСТЬ
Norwegian Heterotopisk graviditet, Heterotopisk svangerskap