A 30-year-old woman presents with 5 weeks amenorrhea, serum β-hCG of 4200 mIU/mL, and transvaginal ultrasound showing BOTH an intrauterine gestational sac with a yolk sac AND a separate adnexal mass with a tubal ring. What is the diagnosis?

• A Molar pregnancy with theca lutein cysts
• B Interstitial ectopic pregnancy
• C Incomplete abortion with a corpus luteum cyst
• D Heterotopic pregnancy ✓

Explanation

Heterotopic pregnancy is the coexistence of an intrauterine and an ectopic pregnancy simultaneously. It occurs in approximately 1 in 30,000 spontaneous pregnancies but is far more common with assisted reproduction (1 in 100). The presence of a confirmed intrauterine sac plus a separate tubal ring establishes this diagnosis. Interstitial ectopic occurs in the cornual region, not with a concurrent intrauterine pregnancy.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.