PMC4896227_01
37-year-old woman with heterotopic pregnancy. At presentation, transvaginal ultrasound of the uterus showing an intrauterine gestation with a crown-rump length (CRL) of 6 mm corresponding to a 6 week 3 day gestation.
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A transvaginal ultrasound was performed, which demonstrated a 6-week and 3-day intrauterine gestation with positive fetal cardiac activity (Figure 1A, Figure 1B). Within the gestational sac, a small yolk sac and fetal pole were identified, corresponding to a 6-week and 0-day gestation (Figure 1C). This gestation also displayed positive fetal cardiac activity (Figure 1D).
Transvaginal ultrasound showing cardiac activity at 114 beats per minute (BPM) in the intrauterine pregnancy.
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A hysterosalpingogram performed in January 2006, demonstrated lack of tubal patency (Figure 2A). Hysterosalpingogram performed in January, 2007 confirmed tubal patency on the right, with no tubal patency on the left (Figure 2B).
Transvaginal ultrasound of the right adnexa showing an ectopic pregnancy with a CRL of 3.5 mm corresponding to a gestational age of 6 weeks 0 days.
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The intrauterine pregnancy was again identified, with a crown-rump length corresponding to a gestational age of 6 weeks and 5 days (Figure 3A). There was positive fetal cardiac activity (Figure 3B). Both ovaries demonstrated rounded, thick walled cysts with peripheral blood flow consistent with corpus luteum of pregnancy (Figure 3C, Figure 3D).
Transvaginal ultrasound showing cardiac activity at 114 BPM in the ectopic pregnancy.
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An additional follow up pelvic ultrasound 12 days later showed progression of the intrauterine pregnancy, with a gestational age of 8 weeks and 3 days (Figure 4A). Normal fetal heart tones were documented (Figure 4B).