Objective:

To explore the impacts of clinical features, surgical timing, embryo transfer type, and ectopic pregnancy location on intrauterine pregnancy outcomes among heterotopic pregnancy patients, with the goal of offering evidence-based guidance for clinical management.

Approach:

• Study Design: A retrospective analysis of 33 patients with clinically diagnosed heterotopic pregnancy admitted to our center between June 2019 and September 2025.

Key Findings:

• 66.67% of patients attained viable ongoing intrauterine gestation or live birth.
• No fetal structural malformations were observed during follow-up.
• Sequential identification of intrauterine gestational sac, embryo, and fetal cardiac activity was associated with higher odds of successful intrauterine pregnancy.
• Fetal cardiac activity had the strongest predictive value for sustained pregnancy and live birth (OR = 22.00, 95% CI 3.24–149.30, P < 0.001).
• No significant differences in outcomes between blastocyst and fresh embryo transfers versus cleavage-stage embryos.

Interpretation:

Ultrasonic indicators reflecting intrauterine gestational sac development significantly predicted favorable pregnancy outcomes.

Limitations:

• Small sample size limits generalizability.
• Retrospective design may introduce bias.

Conclusion:

Ultrasonic markers indicating intrauterine development are superior predictors of favorable pregnancy outcomes in heterotopic pregnancies.