Heterotopic pregnancy is a condition in which an ectopic pregnancy coexists with an intrauterine pregnancy. It can be a life-threatening condition and can be easily missed, with the diagnosis being overlooked. A very high degree of suspicion is required to reach the diagnosis. Some of the known risk factors associated are assisted reproductive techniques, infertility, and previous history of pelvic inflammatory disease. The diagnosis is still challengeable in patients with heterotopic pregnancy without identifiable risk factors and with spontaneous pregnancy and those who usually attend first with uncomplicated heterotopic pregnancy, are usually overlooked.