Abstract : Heterotopic pregnancy is the existence of 2 or more simultaneous pregnancies with separate implantation
sites, one of which is tubes or ovaries or other ectopic site. The estimated incidence in the general
population is estimated at 1:35,000 (for a naturally conceived pregnancy).With increasing trend in assisted
reproductive technique, the frequency of heterotopic pregnancies was increased to be between 1:100 to
1:7,000. A 36 yrs third gravida (P1, L1, A1) presented with 2 month amenorrhoea In Doppler usg there was
evidence of irregular solid component at periphery with echogenic tissue around showing ring vascularity
and burning ring fire sign present. There is evidence of mild free fluid collection in the pouch of Doughlas
pre operative and post operative injection 17 –oh progesterone acetate (proleutone) used and post operative
tidilan injection. Left sided laparoscopic salpingectomy was done. The material was collect in endobag
and afterward sent it for histopathological examination which confirms trophoblastic tissue and presence of
ectopic pregnancy. There is no proven role of medical management in this because of high Bhcg titer which
helps to continue it afterwards. Like other cases if there was no facility for laparoscopy, laparotomy for
salpingectomy is another option. Diagnosis of heterotopic rare and challenging but proper ultrasonography
skills and broad mind set helps in diagnosis.
Keywords: Heterotopic ectopic pregnancy, Laparoscopy, Chorionic villi.