Heterotopic pregnancies are increasing in prevalence and this case highlights the importance of excluding the diagnosis in patients with pelvic pain following miscarriage. A known pre-existing intrauterine pregnancy can be falsely reassuring and delay the diagnosis of a potentially life-threatening concurrent ectopic pregnancy. In this report, we describe a case of spontaneous heterotopic pregnancy in a woman who had initially presented with pelvic pain and vaginal bleeding, and was diagnosed on pelvic ultrasound with a missed miscarriage; a non-viable intrauterine pregnancy. She re-presented 7 days later with worsening pelvic pain and bleeding, and a repeat pelvic ultrasound identified a ruptured tubal ectopic pregnancy in addition to an incomplete miscarriage of the previously identified intrauterine pregnancy. She underwent an emergency laparoscopy where a ruptured tubal ectopic pregnancy was confirmed. Being a time critical diagnosis with the potential for an adverse outcome, it is important that the emergency physician considers heterotopic pregnancy as a differential diagnosis in patients presenting with pelvic pain following a recent miscarriage. The same principle should apply to pelvic pain in the context of a known viable intrauterine pregnancy or recent termination of pregnancy. A combination of clinical assessment, beta human chorionic gonadotropin levels, point of care ultrasound and formal transvaginal ultrasound must be utilized together in these situations to explicitly exclude heterotopic pregnancy.

中文翻译：

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流产异位妊娠后的急性盆腔疼痛必须排除：病例报告

异位妊娠的患病率正在增加，该病例凸显了排除流产后骨盆痛患者诊断的重要性。已知的既往宫内妊娠可能会错误地使人放心，并延迟诊断可能危及生命的并发异位妊娠。在本报告中，我们描述了一名女性自发性异位妊娠的病例，该女性最初表现为盆腔疼痛和阴道流血，经盆腔超声检查诊断为流产。不可行的子宫内妊娠。她在7天后再次表现出骨盆疼痛和出血加重，并且再次进行的骨盆超声检查发现，输卵管异位妊娠破裂，以及先前确定的宫腔妊娠不完全流产。她接受了紧急腹腔镜检查，证实了输卵管异位妊娠破裂。作为可能导致不良后果的时间紧迫的诊断，急诊医师将异位妊娠视为近期流产后出现骨盆痛的患者的鉴别诊断，这一点很重要。在已知的可行宫内妊娠或近期终止妊娠的情况下，同样的原则也应适用于骨盆疼痛。在这些情况下，必须将临床评估，β人绒毛膜促性腺激素水平，护理点超声和正式经阴道超声结合起来使用，以明确排除异位妊娠。重要的是，急诊医师应将异位妊娠作为近期流产后出现盆腔疼痛的患者的鉴别诊断。在已知的可行宫内妊娠或近期终止妊娠的情况下，同样的原则也应适用于骨盆疼痛。在这些情况下，必须结合使用临床评估，β人绒毛膜促性腺激素水平，护理点超声和正式经阴道超声的组合，以明确排除异位妊娠。重要的是，急诊医师应将异位妊娠作为近期流产后出现盆腔疼痛的患者的鉴别诊断。在已知的可行宫内妊娠或近期终止妊娠的情况下，同样的原则也应适用于骨盆疼痛。在这些情况下，必须结合使用临床评估，β人绒毛膜促性腺激素水平，护理点超声和正式经阴道超声的组合，以明确排除异位妊娠。