An Advanced Intact Tubal Ectopic Pregnancy with an Alive Foetus of 19 Weeks Gestation; A Rare Case Report

Abstract

Ectopic pregnancy is the leading cause of direct maternal morbidity and mortality in the first trimester of pregnancy worldwide. It can undergo spontaneous resolution or a rupture; leading to serious health consequences, making its early diagnosis imperative. Almost 98% ectopic pregnancies implant in ampullary portion of the fallopian tube. Due to the weak musculature, tubal ectopic pregnancy usually becomes symptomatic around 6-7 weeks of gestation. Rarely it can progress undiagnosed even beyond first trimester, endangering the woman’s life. Here we are presenting such an unusual case of advanced tubal ectopic pregnancy of 19+2 week’s gestation in a young primigravida, referred to our hospital with diagnosis of an extrauterine abdominal pregnancy, on an obstetrical ultrasound done a day earlier in a peripheral health care centre. Owing to uneventful progress of pregnancy, she never had any antenatal checkup till she experienced dull lower abdominal pain for the last few days and had this ever first ultrasound. She was haemdynamically stable with mildly tender abdomen and symphysio-fundal height of 22cm. Our further workup including a detailed obstetric and Doppler ultrasound confirmed the diagnosis of abdominal pregnancy harbouring an alive but anomalous fetus. MRI was unavailable for precise localization of ectopic pregnancy. An exploratory laparotomy was proceeded, revealing an intact, mobile left tubal pregnancy mass 15×15 cm in size, which was excised intact via partial salpingectomy. This case emphasizes the importance of timely and accurate diagnosis of ectopic pregnancy to avoid life-threatening haemorrhagic consequences.