Pregnancy Loss Pregnancy Loss Causes and Risk Factors Heterotopic Pregnancy Causes, Signs, and Diagnosis By Krissi Danielsson Krissi Danielsson Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage. Learn about our editorial process Updated on November 27, 2020 Medically reviewed Verywell Family articles are reviewed by board-certified physicians and family healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Rachel Gurevich, RN Medically reviewed by Rachel Gurevich, RN Facebook LinkedIn Twitter Rachel Gurevich is a fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. She is a professional member of the Association of Health Care Journalists and has been writing about women’s health since 2001. Rachel uses her own experiences with infertility to write compassionate, practical, and supportive articles. Learn about our Medical Review Board Print BSIP / UIG / Getty Images Heterotopic pregnancy is the existence of two simultaneous pregnancies with separate implantation sites, one of which is a viable intrauterine pregnancy (occurring in the uterus) and the other of which is a non-viable ectopic pregnancy (occurring outside of the uterus, usually in a fallopian tube). A heterotopic pregnancy can be every bit as dangerous as an ectopic pregnancy and is made all the more difficult by the fact that most parents wish to keep the viable pregnancy while having to terminate the other. Rates of Heterotopic Pregnancy Like all multiple pregnancies, heterotopic pregnancy is most common in couples who conceive with assisted reproductive procedures like in vitro fertilization (IVF). As many as 1 in 100 assisted pregnancies result in a heterotopic pregnancy. While far less common in women who have a spontaneous (natural) conception, some estimates suggest that the rate of heterotopic pregnancy is still significant, ranging from 1 in 7,000 to 1 in 30,000 pregnancies. Symptoms A woman experiencing a heterotopic pregnancy may or may not have symptoms. This is especially concerning since half of these pregnancies are only diagnosed when the fallopian tube ruptures. If symptoms are present, they may include: Abnormal vaginal bleedingBloatingDizzinessFaintingMild-to-severe abdominal pain or crampingNauseaPain in the sideVomiting If you are experiencing severe pain, heavy bleeding, feeling faint, or have any other worrisome symptoms, go to the emergency room, as a ruptured tube can be deadly if untreated. Diagnosis Quite simply, it is difficult for doctors to diagnose heterotopic pregnancy in its early stages. Women may have vaginal bleeding and cramping, but these are symptoms that can occur even in a normal pregnancy. At the same time, it is easy to miss a heterotopic pregnancy during a routine ultrasound since the technician may only check the developing fetus in the uterus and not think to look beyond that. If there is a suspicion of a heterotopic pregnancy, it usually is only by week four or five that it can be confirmed or ruled out by ultrasound. Until then, the pregnant person would need to be monitored closely with blood tests until a definitive diagnosis can be made. The same should apply to people who have undergone an assisted reproductive procedure if experiencing any of the above-listed symptoms. Treatment Any fetus located outside the uterus cannot survive, and its presence could cause potentially life-threatening bleeding in the mother if a tissue spontaneously ruptures. As a result, these pregnancies must be terminated. The good news is that it is often possible to do so without terminating the healthy intrauterine pregnancy. This process typically involves surgery, which may or may not require the removal of the affected fallopian tube. While heterotopic pregnancies carry an increased risk of miscarriage (particularly if a rupture is involved), around 67% of women are able to carry the intrauterine baby to term. If you have experienced loss of a fetus due to a heterotopic pregnancy, it is perfectly normal if you find yourself grieving that baby even if the other is fine. Allow yourself to feel and share that loss with others you trust. Was this page helpful? Thanks for your feedback! Get diet and wellness tips delivered to your inbox. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 2 Sources Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Bildner, A. M. Sonographic detection of a heterotopic pregnancy in natural conception. Journal of Diagnostic Medical Sonography. 2014;30(2):92–96. doi:10.1177/8756479313517768 Gibson KR, Horne AW. Ruptured heterotopic pregnancy: An unusual presentation of an uncommon clinical problem. BMJ Case Rep. 2012;2012. doi:10.11362Fbcr-2012-007423 Additional Reading Baheti, S. and Jayakrishnan, K. "Heterotopic Pregnancy in a Natural Conception." International Journal of Infertility and Fetal Medicine. 2010; 1(1):41-43 Bildner, A. "Sonographic Detection of a Heterotopic Pregnancy in Natural Conception."& Journal of Diagnostic Medical Sonography. 2014; 30(2):92-92.