Advanced Fimbrial Ectopic Pregnancy Resulting in Live Birth

Abstract

Abstract

Background: Advanced fimbrial pregnancy resulting in live birth is a very rare entity and only 1 such case was reported in the literature. Case: A 30-year-old multigravida with no risk factors for ectopic pregnancy underwent a medical termination of pregnancy (MTP) and laparoscopic sterilization at 5 weeks and 5 days of pregnancy at a nursing home. She had minimal bleeding for 2 days following the procedure and suffered later with recurrent vomiting and fever and was hospitalized elsewhere for the same condition about 3 months later. She was diagnosed as having enteric fever and was accordingly treated. As she felt fetal movement, she approached a gynecologist who performed an ultrasound and diagnosed her as having intrauterine pregnancy of 32 weeks gestation with a breech presentation with oligohydramnios. When she came to our Institution, she was mildly pale with superficial fetal parts being felt in a 32-week-sized abdomen. Ultrasonography (USG) confirmed secondary abdominal pregnancy of a live fetus in breech presentation at 33 weeks without any anomalies. During conservative management, she had sudden pain in the abdomen with tachycardia, and the pregnancy was terminated by emergency laparotomy. The fetus was alive in the transverse position in the peritoneal cavity and weighed 2.8 kg and had minimal right-sided cranial asymmetry. The placenta was implanted on the left fimbrial end of the fallopian tube and derived its blood supply from the infundibulopelvic ligament. Conclusions: This case illustrates that if one is not careful in tracing the fallopian tube in its entire length at the time of sterilization, an ectopic pregnancy can be missed, which may be fatal. It is also essential to perform a transvaginal USG prior to MTP in cases of early pregnancy to avoid this happening. Onset of pain abdomen and tachycardia denote a rupture of the amniotic sac in cases of abdominal pregnancy on conservative treatment, and one should act upon it and do a laparotomy to save the fetus and mother from hemorrhage, as separation of the placenta can take place after a rupture of the amniotic sac, in some cases. (J GYNECOL SURG 26:57)