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Case Reports
. 2023 Aug 22;23(1):599.
doi: 10.1186/s12884-023-05909-7.

Retroperitoneal ectopic pregnancy: successful expectant management in condition of early pregnancy failure

Diep Ngoc Le #  1 , Phuc Nhon Nguyen #  2   3 , Phuong Hai Huynh  4
Affiliations
Case Reports

Retroperitoneal ectopic pregnancy: successful expectant management in condition of early pregnancy failure

Diep Ngoc Le et al. BMC Pregnancy Childbirth. .

Abstract

Background: Retroperitoneal ectopic pregnancy (REP) refers to abnormal implantation of the fertilized egg in the retroperitoneal cavity. REP can be divided into pelvic and abdominal positions. Extremely rare, the incidence of REP is less than 1% of ectopic pregnancy (EP). Herein, we report the first case of paraaortic-located REP in association with successful expectant management, thus raising awareness among healthcare providers, particularly in low-resource settings.

Case presentation: A reproductive-age woman presented at our tertiary referral hospital because of amenorrhea and a positive pregnancy test. Based on serial serum β-hCG levels and imaging modalities including transabdominal ultrasound, transvaginal sonography, and magnetic resonance imaging (MRI), a REP of 7-9 weeks of gestational age adherent to abdominal paraaortic region was detected. Since the pregnancy was spontaneously arrested without clinical symptoms, expectant management was first indicated following careful evaluation. After a 1-month follow-up, the ectopic mass naturally degenerated without complications and her β-hCG concentration returned to a negative value. Therefore, the patient recovered completely and avoided unnecessary surgery as well as toxicity of medical treatment when using systemic methotrexate.

Conclusions: In addition to transvaginal and transabdominal ultrasound, MRI is necessary for the diagnosis of nonviable REP. Alongside the great vessels in the abdominal cavity should be taken into consideration in all suspected cases relating to this rare entity. Expectant management may be carefully indicated in conditions of nonviable REP and unruptured REP, where applicable.

Keywords: Early pregnancy failure; Ectopic pregnancy; Expectant management; Retroperitoneal ectopic pregnancy; Ultrasound; β-hCG.

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Conflict of interest statement

The authors declare that they have no competing interests. Diep Ngoc Le and Phuc Nhon Nguyen share the first authorship.

Figures

Fig. 1
Fig. 1
Transabdominal ultrasound in a reproductive-age woman (G5P2) revealed the following: a visible embryo 15 mm in length corresponding to 7 weeks and 6 days of gestational age without fetal heart activity (A). The mass is absent with a Doppler signal (B). The gestational sac measured 56 × 60 × 44 mm in dimension and was located in the right upper quadrant of the abdominal cavity (C). The kidneys and surrounding organs are normal (D)
Fig. 2
Fig. 2
Magnetic resonance imaging in a 38-year-old female patient (G5P2) diagnosed a retroperitoneal ectopic pregnancy. Axial image showing a gestational sac measured 4.6cmx5.6cmx5.4 cm in size, invaded to the inferior vena cava in the retroperitoneal space, and tightly adherent to the abdominal aorta and duodenum (A). Coronal and sagittal images showed a gestational mass running from the lower pole of the right kidney, transverse to the vertebral column, and reaching to the bifurcation of the inferior mesenteric artery and two common iliac veins. The genital vein was dilated and in close contact with the gestational mass before attaching to the inferior vena cava. No fluid collection or hematoma was observed in the abdominal cavity (B-C).
Fig. 3
Fig. 3
Variability of β-hCG levels during the expectant management of retroperitoneal ectopic pregnancy
See this image and copyright information in PMC

References

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