{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T05:44:21Z","timestamp":1793252661272,"version":"4.5.0"},"reference-count":18,"publisher":"Federa\u00e7\u00e3o das Associa\u00e7\u00f5es de Ginecologia e Obstetr\u00edcia","issue":"04","license":[{"start":{"date-parts":[[2019,4,10]],"date-time":"2019-04-10T00:00:00Z","timestamp":1554854400000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev Bras Ginecol Obstet"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Heterotopic pregnancy (HP) is defined as the simultaneous development of an intra- and an extra uterine gestation. The occurrence of a spontaneous triplet HP is an exceptionally rare medical condition. We report the case of a young woman with spontaneous heterotopic triplets at 8 weeks of gestation, with a misdiagnosis of topic twins and acute appendicitis. The ectopic tubal pregnancy was ruptured and a salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed uneventfully. The two healthy babies were delivery by cesarean section at 36\u2009\u00b1\u20092 weeks of gestation. Heterotopic triplets with ruptured tubal ectopic pregnancy represent a special diagnostic and therapeutic challenge for the obstetrician. A high rate of clinical suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.<\/jats:p>","DOI":"10.1055\/s-0039-1683910","type":"journal-article","created":{"date-parts":[[2019,4,11]],"date-time":"2019-04-11T02:44:45Z","timestamp":1554950685000},"page":"268-272","source":"Crossref","is-referenced-by-count":13,"title":["Spontaneous Heterotopic Triplet Pregnancy with a Two Viable Intrauterine Embryos and an Ectopic One with Right Tubal Rupture"],"prefix":"10.61622","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0547-5596","authenticated-orcid":false,"given":"Adriano Carvalho","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"V&P Health Excel\u00eancia M\u00e9dica, Santo Ant\u00f4nio da Platina, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano Dias de Oliveira","family":"Reis","sequence":"additional","affiliation":[{"name":"Hospital Nossa Senhora da Sa\u00fade, Santo Ant\u00f4nio da Platina, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio Chaves","family":"Leite","sequence":"additional","affiliation":[{"name":"Hospital Regional do Norte Pioneiro, Santo Ant\u00f4nio da Platina, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassiana Franco Dias dos","family":"Reis","sequence":"additional","affiliation":[{"name":"Hospital Nossa Senhora da Sa\u00fade, Santo Ant\u00f4nio da Platina, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex Paula","family":"Costa","sequence":"additional","affiliation":[{"name":"Hospital Nossa Senhora da Sa\u00fade, Santo Ant\u00f4nio da Platina, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter Junior Boim de","family":"Araujo","sequence":"additional","affiliation":[{"name":"Instituto da Circula\u00e7\u00e3o, Curitiba, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"47794","published-online":{"date-parts":[[2019,4,10]]},"reference":[{"key":"ref1","first-page":"509694","article-title":"Spontaneous heterotopic pregnancy, simultaneous ovarian, and intrauterine: a case report","volume":"2012","author":"F Basile","year":"2012","journal-title":"Case Rep Obstet Gynecol"},{"key":"ref2","first-page":"356131","article-title":"Heterotopic triplet pregnancy after in vitro fertilization with favorable outcome of the intrauterine twin pregnancy subsequent to surgical treatment of the tubal pregnancy","volume":"2014","author":"T Felekis","year":"2014","journal-title":"Case Rep Obstet Gynecol"},{"key":"ref3","first-page":"317592","article-title":"Diagnosis of heterotopic pregnancy using ultrasound and magnetic resonance imaging in the first trimester of pregnancy: a case report","volume":"2012","author":"S Y Sun","year":"2012","journal-title":"Case Rep Radiol"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1007\/s004040100213","article-title":"Simultaneous intrauterine and ovarian pregnancy following treatment with clomiphene citrate","volume":"266","author":"D O Selo-Ojeme","year":"2002","journal-title":"Arch Gynecol Obstet"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s00404-010-1577-z","article-title":"Heterotopic triplets: tubal ectopic and twin intrauterine pregnancy. 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