Which condition describes the presence of both an extrauterine and intrauterine pregnancy, typically with a complex adnexal mass and posterior cul-de-sac fluid?

• A. Heterotopic pregnancy
• B. Anembryoic
• C. Subchorionic hemorrhage
• D. Corpus luteum

Answer: (A)

Heterotopic pregnancy is the presence of both an intrauterine and an extrauterine pregnancy at the same time. On ultrasound, you’d see a viable intrauterine gestation while also identifying a separate adnexal mass that represents the ectopic component, and there may be free fluid in the posterior cul-de-sac from bleeding if the ectopic pregnancy has ruptured. This dual-gestation pattern is what sets the diagnosis apart. Other conditions involve only intrauterine pregnancy with abnormalities (like anembryonic pregnancy, where there is a gestational sac without an embryo; or subchorionic hemorrhage, which is bleeding around the intrauterine sac) or an ovarian structure such as the corpus luteum that can appear as an adnexal mass but does not include an additional (extrauterine) gestation.