title: Heterotopic pregnancy diagnosed before the onset of severe symptoms: case report.
abstract: BACKGROUND
  A heterotopic pregnancy (HP) is an extremely rare disease that represents the simultaneous occurrence of two or more implantation sites in the uterus and extrauterus. Early diagnosis of HP is difficult because of the presence of an intrauterine pregnancy (IUP). In most cases, a precise diagnosis was made after symptoms develop through the rupture or bleeding of the ectopic pregnancy (EP). The authors present a case that was successfully diagnosed as an undemonstrative HP.
  
  
  METHODS
  A 24-year-old multiparous woman became pregnant after taking clomiphene citrate. At ten weeks of pregnancy, an ultrasonography revealed gestational sacs containing fetuses in the uterus and the right adnexal region, respectively. The patient was diagnosed as having a HP and an emergency right tubal resectomy was performed. The IUP progressed normally and the fetus was delivered at 37 weeks of pregnancy.
  
  
  CONCLUSIONS
  Even if a gestational sac can be confirmed in the uterus, a careful ultrasonographic examination should always be considered to determine the presence of a concurrent extrauterine pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Chibune General Hospital, Osaka, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Yamamoto
authors.forename: H
authors.initials: H
authors.lastname: Murakoshi
authors.forename: Y
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Y
authors.initials: Y
authors.lastname: Ejima
authors.forename: S
authors.initials: S
authors.lastname: Yoshida
authors.forename: S
authors.initials: S
authors.lastname: Motoyama
mesh_terms: D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D063192:Pregnancy, Heterotopic / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012421:Rupture; D016216:Ultrasonography, Prenatal; D055815:Young Adult