Abstract
Heterotopic pregnancy is a rare condition where intrauterine and extrauterine pregnancies occur simultaneously, posing significant diagnostic and management challenges. Timely recognition is critical, as it can lead to severe complications like rupture and hemorrhage and become a life-threatening condition if the ectopic component is not promptly addressed. This condition often requires careful monitoring and a tailored treatment approach to ensure the safety of both the mother and the intrauterine pregnancy. We reported a case of a 29-year-old woman, gravida 2para 1, who presented with lower abdominal pain in Prince Rashid Military Hospital/Jordanian Royal Medical Services, who was found to have a ruptured right tubal ectopic pregnancy with a significant amount of free fluid, despite having two intrauterine gestational sacs with viable fetuses. This case shows the significance of maintaining a high level of suspicion for heterotopic pregnancy. Recurrent imaging, symptom monitoring, and careful evaluation are essential for rapid diagnosis and decreasing maternal morbidity.