Abstract
Background: Heterotopic pregnancy is a rare condition that refers to the simultaneous existence of intrauterine pregnancy (IUP) and ectopic pregnancy. It is a life-threatening condition that requires early diagnosis and prompt management.
Case Presentation: A 30-year-old African pregnant woman was presented to the emergency department complaining of severe abdominal pain, especially on the right side. She was checked for history and underwent a physical examination and ultrasound which reveals intrauterine pregnancy with right adnexal mass. While undergoing laparotomy for management of the adnexal mass, a small fetus was found; therefore, a right salpingo- oophorectomy for removal of this ectopic pregnancy was done. She was improved and discharged in good condition with a recommendation to follow up on her pregnancy. Five months later, she was admitted again as she experienced an eclamptic fit with tonic-clonic convulsion lasting for 10 minutes. She experienced a deteriorating condition that required medical termination of pregnancy. She did not improve and she was admitted to the intensive care unit and well-managed, then she improved and was shifted to the ward for observation for 10 days and then discharged in good condition.
Conclusion: The presence of IUP does not exclude the presence of ectopic pregnancy. Follow-up during pregnancy is necessary, especially if the patient is known to have previous gestational complications. Examination using transvaginal ultrasound is necessary for early diagnosis of heterotropic pregnancy (HP). Surgical treatment of HP and subsequent follow-up can contribute to maintaining IUP and its successful delivery.

Key words: HP, ectopic pregnancy, outcomes, IUP, case report.