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| CASE REPORT |
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| Year : 2022 | Volume
: 7
| Issue : 2 | Page : 314-316 |
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A rare case report of bilateral ruptured tubal ectopic pregnancy
Preeti Shankar Malapure, Rajasri G Yaliwal, Purushottam B Jaju, Gauri Bankapur
Department of OBG, Shri B. M. Patil MC and RC BLDE (DU), Sajjan Campus, Vijayapura, Karnataka, India
| Date of Submission | 29-Apr-2022 |
| Date of Acceptance | 17-Aug-2022 |
| Date of Web Publication | 06-Dec-2022 |
Correspondence Address:
Preeti Shankar Malapure
Department of OBG, Shri B. M. Patil MC and RC BLDE (DU), Sajjan Campus, Vijayapura, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/bjhs.bjhs_65_22
Implantation of the fertilized ovum outside the uterine cavity is called ectopic gestation. The common presenting symptoms are per vaginal bleeding till 12 weeks, pain in the lower abdomen, and absence of menses. ß-HCG level is increased (>1000IU/L) and transvaginal ultrasonography shows an empty uterus. These findings essentially confirm the diagnosis. In this, we have a 23-year-old, G2P1L1 with a history of 3 months of amenorrhea, presenting to the labor ward with a history of per vaginal bleeding and lower abdominal pain. The diagnosis was 10 weeks right-sided ruptured ectopic pregnancy and intraoperatively found to be ruptured ectopic pregnancy in both fallopian tubes which we managed successfully by performing emergency laparotomy with bilateral partial salpingectomy.
Keywords: Absence of menses, both side tubal ectopic pregnancy, exploratory laparotomy, transvaginal ultrasound
How to cite this article:
Malapure PS, Yaliwal RG, Jaju PB, Bankapur G. A rare case report of bilateral ruptured tubal ectopic pregnancy. BLDE Univ J Health Sci 2022;7:314-6 |
An ectopic pregnancy is the consequence of abnormal implantation of the blastocyst. The most common sites are in fallopian tubes (95%–98%), uterus cornu (2%–2.5%), ovary, cervix, and abdominal cavity (<1%) and it is more common on the right side.[1] The overall rate of ectopic pregnancies is 1%–2% and the rate increases with the age.[2] It is suspected when a woman complains of the following symptoms in the early trimester of pregnancy such as per vaginal bleeding, pain in the lower abdomen, and absence of menses. The criteria for diagnosis of ectopic pregnancy are transvaginal ultrasound and ß-HCG levels. This article reports a very rare case of bi lateral (B/L) ruptured ectopic pregnancy in both fallopian tubes at 10 weeks of gestation which was identified and managed at Shri B M Patil Medical College, Hospital and Research Institute, Vijayapura.
| Case Report | |  |
A young 23-year-old female, gravida 2, para 1, living 1, with a history of 3 months of amenorrhea presented to the labor ward with complaints of per vaginal bleeding and pain on the right side of the lower abdomen. She later developed pain on the left side of the lower abdomen radiating to the back associated with excessive sweating and four episodes of vomiting. Her past obstetric history included lower segment cesarean section (LSCS) 1.5 years back in view of nonprogression of labor. Moreover, after the previous delivery, her cycles were irregular and her last menstrual period was 3 months back, bled for 4 days, and gives a history of changing 1 pad/day. On general examination, she was pale and had tachycardia and low diastolic blood pressure. On per abdomen examination, tenderness was present both in the right and left iliac fossa and minimal bleeding was present on per speculum examination with right forniceal fullness and tenderness on per vaginal examination. The examination was complemented by bedside transvaginal ultrasonography [Figure 1], which showed a sac-like lesion measuring 10 mm with surrounding echogenicity in the right adnexa and moderate echogenic free fluid in the pouch of douglas, and a urine pregnancy test was positive. Her routine investigations, were hemoglobin (Hb) was 12.6g/dl, white blood cell-, 15, 320 cells/mm3, O positive blood group, and an INR of 1.1.
The possibility of rupture of ectopic pregnancy was explained to the patient, and she was immediately posted for emergency laparotomy with salpingectomy after taking informed written consent. During the laparotomy [Figure 2], 100 ml of blood was drained. Both right and left ruptured tubal ectopic were found to size approximately 8 cm × 3 cm on the right side and 2 cm × 2 cm on the left side. Both right and left fallopian tubes were resected and ligated and sent for histopathological examination.
The histopathological report [Figure 3] revealed large areas of hemorrhage fibrin deposits along with chorionic villi lined by cytotrophoblasts and syncytiotrophoblasts in the lumen of both right and left fallopian tube consistent with the bilateral ectopic fallopian tube.
Intraoperatively, her vitals were stable, and immediately after OT, she was shifted to the ward for intensive monitoring. Her repeat Hb on post operative day (POD)2 was 10 gm/l and she was discharged on POD8 in stable condition after suture removal and she has been advised for in vitro fertilization for her future pregnancies
| Discussion | | |
Ectopic pregnancy as an early trimester pregnancy complication is a lethal condition. It is accountable for 9%–13% of maternal mortality and thus a substantial cause contributing to maternal mortality.[3]
One of the risk factors associated with tubal ectopic pregnancy is previous ectopic pregnancy and the strongest risk factor. The rates for intrauterine pregnancy (40%) and ectopic pregnancy (15%) are similar after salpingectomy or conservation treatment.[4] The 10-year incidence of tubal ectopic is 7.3/1000 after any sterilization technique,[5] recanalization increases the risk for ectopic pregnancy.
Other risk factors are a pelvic infection that is the incidence of tubal blockage increases with each new episode of pelvic inflammatory disease (PID) that is 13%, 35%, and 75% after 1st, 2nd, and 3rd episodes, respectively, and chlamydia is the most important causative agent of tubal blockage some other risk factors include infertility, smoking, and contraceptive use.
Treatment options were decided based on hemodynamic status of the patient, serum ß-HCG level, gestational sac size, and willingness for future fertility.
In our scenario, an emergency laparotomy with bilateral partial removal of fallopian tubes was performed due to the ruptured ectopic pregnancy in both sides fallopian tubes, unstable hemodynamic status of the patient, and presence of free fluid in the POD.
| Conclusion | | |
Bilateral ruptured tubal ectopic pregnancy is very unusual and poses a big challenge as it affects the further childbearing capacity of the affected woman. This case report emphasizes the need to inspect the opposite adnexa carefully for any possible pathology after clamping the tube with ectopic mass. This helps in reducing further blood loss and possible complications for the patient.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Barash JH, Buchanan EM, Hillson C. Diagnosis and management of ectopic pregnancy. Am Fam Physician 2014;90:34-40.  |
| 2. | Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol 2010;115:495-502. |
| 3. | Taran FA, Kagan KO, Hübner M, Hoopmann M, Wallwiener D, Brucker S. The Diagnosis and treatment of ectopic pregnancy. Dtsch Arztebl Int 2015;112:693-703. |
| 4. | Farquhar CM. Ectopic pregnancy. Lancet 2005;366:583-91. |
| 5. | Peterson HB, Xia Z, Hughes JM, Wilcox LS, Tylor LR, Trussell J. The risk of pregnancy after tubal sterilization: Findings from the U.S. Collaborative review of sterilization. Am J Obstet Gynecol 1996;174:1161-8. |
[Figure 1], [Figure 2], [Figure 3]
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