DOI: https://doi.org/10.36347/sjmcr.2026.v14i09.025

Pages: 2063-2066

Heterotopic pregnancy—the simultaneous presence of intrauterine and extrauterine gestations—is rare after spontaneous conception. Diagnostic delay is common because visualising a viable intrauterine pregnancy often provides false reassurance, leading clinicians to miss coexisting adnexal pathology. We report the case of a 30-year-old woman (gravida 3, para 1) who presented three months postpartum while exclusively breastfeeding and developed profound haemorrhagic shock secondary to a ruptured left interstitial ectopic pregnancy coexisting with a viable 8–9-week intrauterine pregnancy. Her history included a spontaneous miscarriage 18 months prior and an uncomplicated term vacuum-assisted delivery three months before admission. She presented with acute lower abdominal pain and diarrhoea, notably without per-vaginal bleeding, following a self-limiting episode of shoulder-tip pain five days earlier. Ambulance vitals demonstrated severe hypotension and tachycardia. Rapidly falling haemoglobin levels and persistent haemodynamic instability prompted an emergency midline laparotomy rather than laparoscopy. Surgery revealed 3.3–3.5 L of haemoperitoneum and a ruptured left interstitial ectopic pregnancy. She underwent a left salpingectomy with interstitial wedge resection and was transfused 8 units of packed red blood cells and 2 pools of platelets under the major haemorrhage protocol. Following intensive care stabilisation, the intrauterine pregnancy remained viable and progressed to an uncomplicated term live birth at 40 weeks. This case emphasises that ovulation can resume within weeks of delivery despite exclusive breastfeeding, that pelvic haemoperitoneum can present with gastrointestinal symptoms without vaginal bleeding, and that a confirmed intrauterine pregnancy does not rule out a concurrent ectopic gestation.