Unsupervised Medical Termination Revealing a Heterotopic Pregnancy: A Clinical and Surgical Challenge

Heterotopic pregnancy, defined as the simultaneous occurrence of intrauterine and extrauterine gestations, is usually diagnosed in the first trimester. Its incidence is notably higher in women undergoing assisted reproductive techniques compared with those conceiving naturally. When pregnancy termination is required in the first trimester, medical termination with appropriate supervision is generally recommended. However, unsupervised use of medical abortion drugs poses significant risks, particularly in undiagnosed heterotopic pregnancies.

Case Description

We report a case of heterotopic pregnancy following natural conception in a 28-year-old woman who attempted medical termination without medical consultation. The patient self-administered over-the-counter abortifacient medications, which failed to terminate the extrauterine component of the pregnancy and ultimately resulted in rupture of the ectopic gestation. She presented to a tertiary care center with acute abdomen and hemodynamic instability. Emergency exploratory laparotomy was performed, during which the ruptured ectopic pregnancy was managed surgically. Suction evacuation of the intrauterine contents was also completed. The postoperative course was uneventful, and the patient recovered well.

Conclusion

Unsupervised use of over-the-counter medications for medical termination of pregnancy can lead to serious, life-threatening complications. The risk is particularly heightened in heterotopic pregnancies, where the extrauterine gestation is not addressed by medical abortion agents.

Clinical Significance

Existing literature highlights the dangers of unsupervised medical termination of pregnancy; these risks are amplified in heterotopic pregnancy, where diagnosis is often delayed. This case underscores the need to increase awareness that pregnancy termination—especially in early gestation—must be performed under strict medical supervision. Early evaluation and appropriate management are critical to preventing severe morbidity and potential mortality.