Heterotopic pregnancy in a rural area in Haiti: case report

Abstract

Heterotopic pregnancy can be defined as the coexistence of at least two pregnancies in different implantation sites. It’s a rare entity, but its diagnosis is becoming more common because of assisted reproduction techniques and ultrasound improvement techniques. The clinical symptoms are also similar to ectopic pregnancy, but a high suspicion index is needed to avoid diagnosis delay and subsequent unfavourable outcomes. This is the case of a 36-year-old female with heterotopic pregnancy who presented with shock symptoms and substantial delay in diagnosis due to socio-political crisis in Haiti at the time. Initial hemoglobin was at 6 g/dl. Transabdominal ultrasound showed an intra-uterine live fetus of 11 weeks 6 days along with a left adnexal mass and free fluid in the Douglas cul-de-sac. She was urgently transferred to the operation room where we performed a left annexectomy through laparotomy. She didn’t get blood transfusion due to shortage at the blood bank of the hospital. The patient’s post-op and pregnancy course were uneventful until the vaginal birth of her child who is alive and well today. We want to highlight the importance of optimizing healthcare access to the most vulnerable and careful adnexal evaluation. It is also important to reinforce the health system in Haiti to secure prenatal care and blood transfusion for all pregnant women.