title: Concealed heterotopic pregnancy at 12 weeks, with no coexisting risk factors: Lessons to be learned.
abstract: A woman presented at the gynecological emergency clinic with severe lower abdominal pain. Even though she reported normal menses and had no risk factors for ectopic pregnancy, pregnancy test was positive and vaginal sonogram indicated heterotopic pregnancy at 12 weeks of gestation, with rupture of the ectopic pregnancy. Laboratory results indicated significant blood loss, and emergency laparotomy with salpingo-ophorectomy was performed. The intrauterine pregnancy continued uneventfully. Interestingly, the previous month the patient had also undergone investigation for vague abdominal pain and anemia. This case, apart from being very interesting because of the rarity of naturally occurring heterotopic pregnancy, shows how a number of factors in patient management and investigation, when combined with rare and uncommon conditions, can lead to incorrect diagnosis with the associated implications for patient safety. This case therefore demonstrates the need for improved patient care and outcome.
authors.affiliation: Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Pratilas
authors.affiliation: Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Chatzis
authors.affiliation: Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Panteleris
authors.affiliation: Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: Kimon
authors.initials: K
authors.lastname: Chatzistamatiou
authors.affiliation: First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: Leonidas
authors.initials: L
authors.lastname: Zeipiridis
authors.affiliation: Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dinas
mesh_terms: D015746:Abdominal Pain / Q000150:complications / Q000175:diagnosis; D000328:Adult; D000740:Anemia / Q000150:complications / Q000175:diagnosis; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D063192:Pregnancy, Heterotopic / Q000000981:diagnostic imaging* / Q000601:surgery; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging* / Q000601:surgery; D012489:Salpingostomy; D016216:Ultrasonography, Prenatal
keywords: concealed; heterotopic; investigation; management; rupture