a case study of heterotype

introduction: heterotype pregnancy has been defined as coexistence of intrauterine and ectopic pregnancy. coexistence of intrauterine and ovarian pregnancy is rare and often occurs in women who use intra-uterine device (iud) or women under assisted reproductive technology. we report a case who presented abdominal pain and an adenexal mass in ultrasound scanning. post-operative diagnosis was coexistence of intrauterine and ovarian pregnancy. case report: the paitent was a 29 year  old woman g4p3 who presented abdominal pain, nausea, vomiting and a four months history of menstrural  cessassion and a two months history of spotting. on physical examination, her uterus was in approximatly the  18 th week stage of pregnancy. there was abvious tenderness in llq. a firm mass estimated to be about 3 cm was palpable. in clinical and paraclinical evaluations she had 17 week intrauterine pregnancy and a left adenexal  mass with 7.5 week pregnancy sac without heart bit. post-operative pathological examination revealed heterotype pregnancy with ovarian pregnancy. discussion: heterotype pregnancy is rare and the vast majority of cases are a coexistence of tubal and intra-uterine pregnancy. coexistence of intrauterine and ovarian pregnancy is very rare. probably, the predisposing factor in this patient was the use of iud. recently, this has been reported frequently in cases of ovarian heterotype pregnancy. in this patient, ovarian tissue was seen around the pregnancy sac. the most common symptom is abdominal pain followed by delay in menstruation cycle and spotting. diagnosis of ovarian pregnancy accompanied by intra-uterine pregnancy is difficult. in this situation serial measurment of  hcg is not useful, since the intra-uterine pregnancy causes appropriate rise in hcg concentration. on the other hand, ultrasonography may show false negative results in the detection of ectopic pregnancy or make incorrect diagnosis of corpus louteum cyst.