Conclusions
Heterotopic pregnancy is a very rare condition that requires a high index of clinical suspicion that may occasionally face health care professionals in obstetrics, gynecology and emergency departments. It is even less common after a spontaneous conception. Although a high index of suspicion for ectopic pregnancy is part and parcel of the clinical practice, yet the guard can at times lower when seeing an intrauterine pregnancy with many cases of heterotopic pregnancy misdiagnosed and a good number only discovered at later stages after rupture of the ectopic arm of heterotopic pregnancy. We believe that cases like this one can play a small part to help keep that vigilance. Ultrasound remains the imaging modality of choice in diagnosing a heterotopic pregnancy, however, in carefully selected cases, an MRI with a reported safety in the first trimester can be utilized and may provide added information over ultrasound. Salpingectomy rather than salpingotomy via laparoscopy should be the treatment of choice in most heterotopic pregnancies with the extrauterine pregnancy in the tube.