Rupture of fetal membrane in ectopic tubal pregnancy: A case report and literature review

Abstract

Rationale: Ruptured tubal pregnancies occurring in the second trimester are rare; yet, they pose a critical risk of life-threatening hemorrhage. This study aims to highlight the importance of timely surgical intervention in such cases to prevent fatal outcomes. The case underscores the diagnostic and therapeutic challenges that arise when distinguishing between tubal and abdominal pregnancies, particularly in the presence of hemoperitoneum, which can obscure imaging results.

Patient concerns: We present a case involving the spontaneous rupture of a tubal pregnancy at 15 weeks and 3 days of gestation. The patient exhibited elevated beta-human chorionic gonadotropin levels. Initial transabdominal ultrasound suggested an abdominal pregnancy, and computed tomography scans supported these findings.

Diagnoses and interventions: Urgent midline laparotomy revealed the condition to be a tubal pregnancy, contrary to initial imaging. The surgical procedure included the removal of the gestational sac and the affected fallopian tube, followed by abdominal closure. Hemoperitoneum was noted to compromise the accuracy of imaging modalities, complicating the preoperative diagnosis.

Outcomes: Histopathological examination confirmed the diagnosis of tubal pregnancy. The patient had an uneventful recovery and was discharged 7 days post-surgery with stable hemoglobin levels.

Lessons: This case underscores the importance of considering the differential diagnosis of abdominal versus tubal pregnancy in the presence of hemoperitoneum, due to their differing clinical management needs. It offers insights that may guide clinicians in the timely diagnosis and treatment of advanced tubal pregnancies, where prompt surgical intervention is critical.

Figure 1.

Preoperative computed tomography scan of the abdomen with arrow marks showing fetal mass (red) and bloody effusions (white).

Figure 2.

Transabdominal ultrasound of abdominal cavity showing the living fetus with a gestational age of 15 weeks and 3 days.

Figure 3.

Images of ruptured tubal ectopic amniotic cavity with fetus and placenta.

Figure 4.

Microscopic histological sections further supported the diagnosis of tubal pregnancy which showed the wall of fallopian tube and a tubal pregnancy with decidua, chorionic villi, and syncytiotrophoblast inside the fallopian tube (×10).