Simultaneous intrauterine and extrauterine pregnancy

A case of simultaneous intrauterine and extrauterine pregnancy is associated with right-sided tubal pregnancy and rupture in the 8th week of pregnancy and spontaneous parturition in the 42 week. The patient was a 33 year old 4-gravida 2-para with a positive urine test for pregnancy. Ultrasonic examination showed an intact pregnancy in the 7th week. 3 days later the patient presented with severe abdominal pain nausea and vomiting together with diarrhea. Examination showed a generally tender abdomen most sensitive in the McBurney area. Palpation indicated a uterus corresponding to an 8th week of pregnancy enlarged anteflected and somewhat sensitive to pressure adnexa area bilaterally pressure sensitive more so on the right side. The provisional diagnosis was gastroenteritis differential diagnosis appendicitis with pregnancy. The next morning the patient took a sudden turn for the worse with severe anemia tense and sensitive abdomen. A tubular pregnancy on the right was demonstrated histologically. The left hand adnexa were microscopically normal the uterus enlarged normally for the 3rd month of pregnancy. The postoperative phase as well as the course of the simultaneous intrauterine pregnancy was uneventful. A healthy 3700 g girl was delivered spontaneously. From the clinical point of view a diagnosis of simultaneous intrauterine and extrauterine pregnancy seldom occurs because of its rarity. Palpation ultrasound laboratory diagnostics Douglas puncture and pelviscopy and finally laparotomy all may come into play in diagnosis.