Heterotopic pregnancy: what to know

A heterotopic pregnancy means one pregnancy is inside the uterus while another is implanted outside it, usually in a fallopian tube, and it needs urgent specialist care. Seeing an intrauterine pregnancy does not by itself exclude an ectopic pregnancy when symptoms are concerning.

Symptoms may include one-sided pelvic pain, vaginal bleeding, shoulder-tip pain, dizziness or fainting. The pregnancy in the uterus can make the situation less obvious, so clinicians combine symptoms, examination, blood tests and imaging. A [Transvaginal Ultrasound](/treatments/diagnostics-and-imaging/transvaginal-ultrasound/) may examine both the uterus and the areas around the tubes. Previous tubal damage, fertility treatment and [Pelvic Inflammatory Disease](/conditions/pelvic-inflammatory-disease/) can affect risk, but symptoms still require assessment on their own terms.

Contact your maternity or emergency service immediately if this diagnosis is being considered. Do not wait for a routine appointment when pain or bleeding is increasing. The team may monitor your circulation, repeat imaging and plan treatment for the ectopic pregnancy while considering the pregnancy in the uterus. Surgery may be needed to remove the affected tube; a [Salpingectomy](/treatments/gynaecological-surgery/salpingectomy/) is one possible operation. Treatment decisions depend on bleeding, scan findings, stability and pregnancy goals.

Go to emergency care for severe or worsening [Pelvic Pain](/symptoms/pelvic-pain/), fainting, marked dizziness, shoulder-tip pain, heavy vaginal bleeding, weakness, breathlessness or a racing heartbeat. These signs can indicate internal bleeding. If you are pregnant and have new pelvic pain or bleeding, tell the clinician how far along you are and whether a scan has shown a pregnancy in the uterus.

Could there be a pregnancy outside the uterus as well? What did the scan show around each tube and ovary? Do I need emergency surgery or monitoring? How will treatment affect the pregnancy in the uterus, and who will coordinate follow-up?