My Heterotopic Pregnancy With Fraternal Twins Went Undiagnosed Until Emergency Surgery

My first pregnancy with fraternal twins required surgery for an ectopic pregnancy and ended with one healthy baby boy. Here's what my experience was like.

Author Tracey Harrington McCoy's three children
Photo: Courtesy of Tracey Harrington McCoy

"There are definitely two heartbeats in there. You're having twins!" my doctor said excitedly. My brain exploded. Oh my god. Twins? TWINS? TWO babies? At one time? But I have a 1-year-old son. How am I going to manage three children under the age of 2? I was stunned.

I immediately called my mother. "Wow, you were going to have twins no matter what!" she exclaimed. And she was right. Believe it or not, this wasn't the first time I was pregnant with twins.

A Complicated Pregnancy

Two years earlier, after a year of trying the "old-fashioned way" and two months of intrauterine insemination (IUI) fertility treatment, I finally got pregnant. Because I was doing fertility treatment, my pregnancy was confirmed multiple times via internal ultrasound very early on. The doctor checked me at four, five, and six weeks—each time observing one healthy embryo progressing as expected.

The day after my six-week ultrasound, I started feeling intermittent stabs of pain on my right side. I'd never felt anything like it before and was instantly concerned. I immediately called my obstetrician and spoke with one of her nurses.

"Sounds like gas," she said. I told her I was pretty familiar with what gas feels like but she insisted that pregnant people experience severe gas and was sure that's what it was. She reminded me I'd had an internal ultrasound the day before and everything looked good. But the pain continued and started alternating from dull and throbbing to sharp and startling.

I called my doctor back, my voice trembling as I said the pain was getting worse. "Come on in," she said. The doctor did an ultrasound and saw a healthy baby with a healthy heartbeat. "I know it's hard to believe, but it's just gas. I can't tell you the number of women who come in, afraid they're miscarrying, and it's just gas!" the doctor said to me. I got back in my car and drove home, hunched over in pain.

Three hours later my husband came home from work and found me in the fetal position on our bed. I could barely move or talk due to the pain. He carried me to the car and drove to the hospital. The doctors immediately gave me morphine to battle the pain (after promising me it wouldn't hurt the baby) and then tried desperately to figure out what was wrong.

After a radiologist spent 45 minutes doing yet another internal ultrasound, it was discovered I was bleeding internally. Because it had taken so long to figure out what was wrong, I'd lost a tremendous amount of blood. By this point, I was unable to move without searing, shooting pain ripping through my body. At 1 a.m., I was rushed into emergency surgery to find the source of the bleeding—and to make it stop.

Three hours later, I woke up to a haggard husband and an exhausted doctor. He slowly began to explain what happened. As he began surgery, he assumed he'd discover a burst cyst. Instead, he discovered a second embryo attached to my ovary. Since pregnancy outside the uterus isn't sustainable, the embryo ruptured, resulting in severe internal bleeding. The diagnosis: heterotopic pregnancy.

Tracey Harrington McCoy Children Son Kai 2
Courtesy of Tracey Harrington McCoy

The Diagnosis

Heterotopic pregnancy is a rare complication in which both an extra-uterine (ectopic pregnancy) and an intrauterine pregnancy occur simultaneously. Essentially, it's two pregnancies happening at the same time, one in the uterus and one outside the uterus. In most cases, the second non-viable pregnancy ruptures in the fallopian tube. In rare cases, it can implant and rupture on the cervix or an ovary, as it did in my case.

The trickiest part about heterotopic pregnancy is how difficult it is to diagnose. When pregnant people experience spotting or abdominal pain, it's easy to dismiss these symptoms as an expected side effect of pregnancy, particularly after ultrasounds show a normal, healthy pregnancy progressing in the uterus. In more than half the cases, a diagnosis doesn't happen until surgery.

This complication can be life-threatening, not only to the pregnant person but to the viable pregnancy in the uterus, as well. That's why it's important to know the symptoms and indications. Also, it's important to note that it's very rare for heterotopic pregnancies to happen with natural conception. Most often, this condition occurs after fertility treatments.

Heterotopic Pregnancy Symptoms

Symptoms to watch for are frequent and intensifying abdominal pain on one side, dizziness, fainting, abnormal bleeding, nausea, and vomiting. If fertility treatments were used and any of these symptoms are present during the first trimester, it's important to assess the possibility of heterotopic pregnancy. Though it's rare, the incidence is increasing every year as fertility treatments become more common.

In my case, the doctor was able to save my other pregnancy and my ovary. My son Kai was born full-term seven months later and was unaffected by the surgery. And 20 months later, my identical twin daughters Ryan and Reese were born full-term and healthy. My mom was right—one way or another, I was going to have twins!

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