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Introduction: Heterotopic pregnancy is the occurrence of pregnancies in at least two different implantation sites in the same time. The diagnosis is one of the most difficult of the gynecological emergencies. Objective: To analyse the clinical importance of early diagnosis of heterotopic pregnancy To assess the importance of early intervention for good maternal outcome and in avoiding maternal mortality Method: A 23year old primigravida at 9weeks of gestation presented with minimal bleeding per vagina and pain abdomen. On performing a physical examination, vitals were stable uterus of around 8 weeks size with right forniceal tenderness was noted. Ultrasound shows a IUP of 9weeks with good cardiac activity and right adnexal mass likely ectopic gestational sac. Her beta-hcg 25396 IU/ml. Results: Laparotomy confirmed right tubal pregnancy and salpingectomy was performed. Post-operative period was uneventful. Patient continued her intrauterine pregnancy with regular antenatal checkup and is upto 32 weeks of gestation. Conclusions: The diagnosis of heterotopic pregnancy should not be delayed by the discovery of an intra-uterine gestational sac in symptomatic women. It is very crucial to inspect the adnexa completely in first trimester ultrasonogram. The diagnosis is often difficult and management should be initiated as soon as possible given the risk of maternal mortality.