Heterotopic pregnancy is a rare but life-threatening condition that represents the simultaneous development of an intrauterine and ectopic pregnancy (most often in the fallopian tube). Risk factors include surgery on the fallopian tubes, previous ectopic pregnancy, inflammatory diseases of the pelvic organs, and the use of assisted reproductive technologies. Diagnosis is difficult due to the nonspecificity of symptoms and the presence of an intrauterine pregnancy, which can lead to a missed diagnosis and dangerous consequences, such as intra-abdominal bleeding. The main goal of treatment is to remove an ectopic pregnancy while preserving the intrauterine pregnancy. Treatment methods include conservative therapy (methotrexate, letrazole, gefitinib) in hemodynamically stable patients with low b-hCG levels, signs of a non-developing intrauterine pregnancy, and surgical intervention (salpingostomy, salpingectomy). Laparoscopic salpingectomy is the most preferred method, as it reduces the risk of complications and recurrence of tubal pregnancy. Objective: to present a clinical observation of heterotopic pregnancy. Materials and methods: medical documentation (medical history of an inpatient, laboratory and instrumental diagnostic data). This clinical case demonstrates the occurrence of spontaneous heterotopic pregnancy without significant risk factors, with the exception of the late reproductive period, which explains its uniqueness. Subjective symptoms (lower abdominal pain, bloody vaginal discharge, severe general weakness) on day 33 of the menstrual cycle were the reason for calling an ambulance and visiting the emergency department. Signs of hemorrhagic shock and ectopic pregnancy identified at the hospital stage were an indication for emergency surgical intervention. The presence of corpora lutea of the same size on both ovaries, an altered right fallopian tube with a fetal receptacle in the isthmic section, an enlarged uterus up to 5 weeks with a fertilized egg in the cavity, allow us to assume the onset of uterine and tubal pregnancy in the same menstrual cycle. Heterotopic pregnancy poses a serious threat to health, especially in connection with the increased use of assisted reproductive technologies. The complexity of diagnosis, the lack of specific signs and the risk of missing an ectopic component require improving diagnostic and treatment protocols, as well as finding ways to reduce the risk of this condition.