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Heterotopic pregnancy (HP) is the co-existence of intrauterine and extrauterine gestations. It is a potentially fatal condition that requires a high degree of suspicion for timely diagnosis. Although rare, it is occurring more frequently because of an increase in genital infection and the escalating use of new reproductive technologies in infertility patients. To our knowledge, no case of combined spontaneous HP and liver cell failure has been reported so far. Also, there is only one reported case of bilateral tubal ectopic gestation with intrauterine pregnancy [1].  In natural conception cycles, HP is a rare event occurring in less than 1:30,000 pregnancies [2, 3]. It is even rarer to carry both the extrauterine and intrauterine pregnancy to viability [4]. During the past decade, the rising incidence of HP following induction of ovulation with clomiphene citrate has been reported [5–7]. Also responsible is the increasing use of new assisted reproductive technologies such as in vitro fertilization (IVF) and embryo transfers (ET) in infertile women [8, 9]. It has, however, stabilized at 1:100 pregnancies with these procedures [10]. The rising incidence of genital tract infection may also be contributory [11].

journal of obstetrics and gynecology of india

Bilateral Tubal Pregnancy with Intrauterine Pregnancy in a Natural Conception Cycle Along with Liver Cell Failure: Case Report and Review of Literature