Heterotopic Pregnancy: An Important Differential for Adnexal Masses in Early Pregnancy 

Introduction:

- Heterotopic pregnancy: when an intra-uterine pregnancy coexists with an ectopic gestation

- Exceedingly rare especially in spontaneous pregnancies, resulting in a higher threshold for diagnosis

- Recent shifts towards delayed parenthood, subfertility and higher in-vitro fertilisation (IVF) uptake have increased its incidence

- If a heterotopic pregnancy is undiagnosed and left untreated, may cause massive haemorrhage, hypovolaemic shock and even death

- Yet, there are currently no formal guidelines regarding the investigation and management of spontaneous, and even IVF-related, heterotopic pregnancies

- Thus, maintaining a high index of suspicion when faced with early pregnancy complications is paramount