Heterotopic pregnancy at term masquerading as intrauterine twin gestation, a case report.

A case of combined intrauterine and abdominal pregnancies in a 29-year-old primigravida occurring in a natural cycle is presented. She booked for routine antenatal care in the obstetric unit of the hospital. An early scan at 10 weeks showed a twin gestation (diamniotic, dichorionic placentation). She was admitted between 10-21 weeks on account of severe hyperemesis gravidarum and anaemia in pregnancy. She was managed with antiemetics, intravenous fluids and two units of blood transfused before discharge for follow up in the antenatal clinic. Pregnancy was uneventful between 22 weeks to 38 weeks when she had elective Caesarean section on account of twin gestation, primigravida and borderline pelvis. At Caesarean section a combined intrauterine and abdominal pregnancies were found. She was delivered of first twin (intrauterine), a baby boy weighing 2.5 kg with Apgar scores of 8 and 9 in 1 and 5 minutes respectively; second twin (abdominal) a baby boy weighing 2.7 kg with Apgar scores of 8 and 9 at 1 and 5 minutes respectively.