Heterotopic abdominal pregnancy following ovulation induction with clomiphene citrate

Background: Heterotopic abdominal pregnancy is a rare entity which poses unique management challenges.
Case: A 24-year-old Gravida 1 woman with history of two years infertility and treatment with clomiphene citrate presented with acute right lower quadrant abdominal pain. Heterotopic abdominal pregnancy was recognized at 16 weeks gestation by transvaginal ultrasound scan. We aimed to remove ectopic pregnancy with prevention of maternal complications and preservation of intrauterine pregnancy (IUP). Surgical removal of the ectopic fetus and placenta was done. Abdominal pregnancy removed successfully without intra- or post-procedural complications, but the IUP was aborted spontaneously on the second postoperative day.
Conclusion: Gynecologists should consider the possibility of heterotopic pregnancy following ovulation induction with clomiphene citrate which is increasing in recent years. A high index of suspicion to heterotopic pregnancy may be followed by a nonsurgical approach safely and affectively, if they are clinically stable and the abdominal pregnancy is recognized early in gestation.

Keywords
Abdominal pregnancy, Clomiphene citrate, Heterotopic pregnancy symptom, Ovulation induction.