Heterotopic Pregnancy or Hemorrhagic Ovarian Cyst in Early Gestation?

Author: Dr Izuchukwu Nwolisa, Dr Karishma Anika (presenter), Dr Himanshu Gul Mirani

Hospital: Midland Metropolitan University Hospital

A 29-year-old woman, approximately six weeks pregnant (spontaneous conception), presented with shoulder tip pain while hemodynamically stable. POCUS revealed an intrauterine gestational sac with free intraperitoneal fluid and bulky right adnexa, raising concern for heterotopic pregnancy. She was transferred to the resuscitation area, where urgent gynecological assessment and review of prior imaging identified a right adnexal cyst (11 × 9 × 12 mm) documented two months earlier. This lesion was suspected to have ruptured, resulting in hemoperitoneum. As heterotopic pregnancy could not be definitively excluded, the patient was admitted for laparoscopic evaluation. This case highlights the diagnostic value of POCUS in early pregnancy complications and the importance of early escalation to gynecology. Although heterotopic pregnancy is rare in spontaneous conceptions (≈1 in 30,000), it remains a critical differential. Conversely, hemorrhagic ovarian cysts can rupture, leading to significant hemoperitoneum and shock, necessitating urgent surgical intervention.