Clinical message
Advanced tubal EP is uncommon and it can never lead to alive fetus.
Diagnosis can be missed easily in the absence of classic symptoms of
spotting, abdominal pain and amenorrhea.
A woman aged 41, referred complaining of spotting. She had amenorrhea
for 2 months.Her medical history was hypertension without any history of
pelvic inflammatory disease.
Physical examination showed abdominal tenderness at left lower quadrant
with normal vital signs.Vaginal examination revealed cervical motion
tenderness and adnexal mass.Laboratory tests showed normal CBC (Complete
Blood Count) and Urinalysis with high βHCG titer.Pelvic ultrasonography
confirmed the presence of adnexal lesion, suggestive of tubal ectopic
pregnancy with an alive fetus. Total salpingectomy was done.
The pathology specimen was an intact dilated fallopian tube measuring
6.5x3.8cm.Longitudinal cut section shows an intact fetus of about 10
weeks gestational age inside a gestational sac(Figure1).
Ectopic pregnancy is a life threatening emergency which can lead to
maternal death and pregnancy loss. Although some women have no
identifiable risk factors, there is often pelvic inflammatory disease in
the background with subsequent lining folds destruction and retention of
the ovum. Other predisposing factors include previous Ectopic pregnancy,
tubal damage due to infection or surgery, congenital tubal anomaly,
increased age and smoking(1).Advanced tubal ectopic pregnancy is
uncommon and never lead to alive fetus .(2) Diagnosis can be missed
easily in the absence of classic symptoms of spotting, abdominal pain
and amenorrhea.