title: Twin heterotopic pregnancy after assisted reproduction. A case report.
abstract: BACKGROUND
  Heterotopic pregnancy is a potentially catastrophic form of ectopic pregnancy and is increasing in incidence secondary to assisted reproductive technology. Early diagnosis and intervention are important in avoiding short- and long-term morbidity.
  
  
  METHODS
  A 36-year-old, nulliparous woman became pregnant by in vitro fertilization and embryo transfer. A total of three embryos were transferred. She presented to the emergency room approximately six weeks after transfer with the complaint of severe abdominal pain. Laboratory analysis revealed a decreasing hematocrit with stable vital signs despite continued abdominal pain. On transvaginal ultrasound, two fetal poles were present, with cardiac activity in two of the three gestational sacs. At surgery the patient was found to have a ruptured tubal pregnancy in addition to the intrauterine gestations. Pathologic analysis revealed a twin tubal pregnancy.
  
  
  CONCLUSIONS
  Heterotopic pregnancy should be considered in the differential diagnosis of any patient who becomes pregnant by assisted reproduction techniques and presents with signs and symptoms of ectopic pregnancy.
authors.affiliation: Departments of Family Practice and of Obstetrics and Gynecology, Dewitt Army Community Hospital, Fort Belvoir, Virginia, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Dammann
authors.forename: Lance
authors.initials: L
authors.lastname: Murphy
authors.forename: Julius
authors.initials: J
authors.lastname: Ellis
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D003937:Diagnosis, Differential; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D011274:Pregnancy, Tubal / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology