Ruptured ectopic pregnancy is one of the outcomes of mis or delayed diagnosis and the massive hemorrhage resulting is responsible for more than three quarters of the first trimester maternal death. Simultaneous presence of intrauterine pregnancy adds obstacles for the correct diagnosis to take place. The management of this condition is a real dilemma as life threatening condition could be the only presentation which needs immediate intervention. The high index of suspicion is mandatory to ensure timely diagnosis and management to prevent stormy outcome.
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