Rare ultrasound diagnosis of unilateral tubal twin ectopic pregnancy

Abstract

Introduction:

Ectopic pregnancies complicate 11/1000 pregnancies in the United Kingdom and contribute significantly to maternal morbidities and mortality. Twin ectopic pregnancies are rare and preoperative diagnosis extremely so. The risk factors and clinical presentation for twin ectopic pregnancies are the same as for ectopic pregnancies in general. The nature of twin ectopic pregnancies, however, implies a potential for higher complication rates. Majority of cases are diagnosed and thus managed surgically; however, successful medical management has been documented with preoperative ultrasound diagnosis.

Case Presentation:

A nulliparous patient presented at six weeks gestation with abdominal pain and vaginal bleeding. An ultrasound diagnosis of right tubal twin ectopic pregnancy was made. She was initially commenced on medical management, but this was abandoned due to worsening symptoms. She subsequently had a laparoscopic right salpingectomy, which was uncomplicated.

Discussion:

The case presented was one of unilateral twin tubal ectopic pregnancy, which is a rare occurrence. In this case, the diagnosis was preoperative unlike most reported cases. Although some reported cases have been successfully managed medically, medical management was unsuccessful in this case, necessitating surgical management.

Conclusion:

Current guidelines for management of ectopic pregnancies do not consider twin ectopic pregnancy, and hence, there is presently no guidance as to the preferred management options for this unique subset of patients. Medical and surgical management options have been utilized successfully in reported cases. While most reported cases were diagnosed and managed surgically, medical management remains an option in carefully selected cases.