Duverney described the first case of an ectopic pregnancy as an autopsy finding in 1708. However, the incidence is higher in women with a history of pelvic inflammatory disease, tubal surgery, previous ectopic pregnancy, or with assisted fertilization through ovulation-stimulating drugs or in vitro fertilization. With assisted reproduction, the incidence as high as 1 in 100 is reported. The majority of heterotopic pregnancies are diagnosed late. Significant morbidity and occasional mortality have been reported as a result of a delay in diagnosis.
Patients frequently present with nonspecific symptoms and signs.
Often, abdominal and pelvic ultrasonography fails to show the ectopic pregnancy or is misinterpreted because of the awareness of an existing uterine pregnancy. Or, if the ectopic pregnancy is diagnosed first, the coexistent uterine pregnancy may not be apparent until it becomes symptomatic or continues to grow. A major pitfall has been the failure to suspect heterotopic pregnancy on the part of a physician. The majority of women present with abdominal pain or vaginal bleeding. They may be totally asymptomatic and may request an abortion of what is considered a normal pregnancy, and, after termination of a uterine pregnancy, the ectopic pregnancy becomes symptomatic.