The Very First Romanian Unruptured 13-Weeks Gestation Tubal Ectopic Pregnancy

Abstract

Tubal ectopic pregnancies remain a challenging and life-threatening obstetric condition in the early stages that unavoidably lead to abortion or rupture, further reflected by the associated maternal mortality. Therefore, in the present case report, we report the experience of a 36-year-old woman who presented to our Emergency Department with a history of moderate hypogastric pain, mild vaginal bleeding, and bilateral mastalgia, symptoms that started 20 days ago after uterine curettage for a declarative eight-week pregnancy. On admission, a physical examination showed regular standard signs. The ultrasound examination revealed in the left abdominal flank a gestational sac with a live fetus corresponding to the gestational age of 13 weeks. Given the position of the gestational sac, we suspected a possible abdominal pregnancy. Independently on her human chorionic gonadotropin (hCG) of 33.980 mIU/mL and hemoglobin (Hb) of 13.4 g/dL, the exact location of the pregnancy following ultrasound was hard to establish. Magnetic resonance imaging (MRI) examination was requested, after which we suspected the diagnosis of ovarian pregnancy. Given the paraclinical and clinical context of the worsening of painful symptoms, we decided to perform an exploratory laparoscopy in the multidisciplinary team (digestive and vascular surgeon) that showed the existence of a tubal pregnancy.

Keywords: ectopic pregnancy; first trimester; live fetus; tubal pregnancy.

Figure 1

Transvaginal ultrasound from a 36-year-old woman with a left ectopic tubal pregnancy of 13 weeks of gestation. Ultrasound showed uterine body with linear endometrium and no gestational sac.

Figure 2

(a) Ultrasound showed in the left abdominal flank a gestational sac with a live fetus corresponding to the gestational age of 13 weeks. (b) Ultrasound showed gestational sac with fetus corresponding to 13 weeks.

Figure 3

Ultrasound examination of the fetus cardiac activity.

Figure 4

MRI examination: coronal T2-weighted (a), axial T2-weighted (b) sagittal T2-weighted (c)—show the ectopic pregnancy on the left ovarian topography.

Figure 4

MRI examination: coronal T2-weighted (a), axial T2-weighted (b) sagittal T2-weighted (c)—show the ectopic pregnancy on the left ovarian topography.

Figure 4

MRI examination: coronal T2-weighted (a), axial T2-weighted (b) sagittal T2-weighted (c)—show the ectopic pregnancy on the left ovarian topography.

Figure 5

(a) Intra-operative image indicating the gestational sac on the left fallopian tube. (b) Intra-operative image indicating the gestational sac on the left fallopian tube.

Figure 6

Intra-operative image after left salpingectomy.

Figure 7

Anatomopathological specimen with the fetus after the removal of the tubal pregnancy from two distinct perspectives (a,b).