Unilateral Viable Twin Tubal Ectopic Pregnancy: A Case Report

 

 

 

Objective: 

Unilteral Twin ectopic pregnancy with a live embryo is a very rare type of Ectopic pregnancy that needs a high index of suspicion to diagnise and treat early to prevent maternal morbidity and mortality

 

Case report:

A 41 year-old Gravida 6 Para 5, presented to the emergency department of King abdulaziz Medical City-Riyadh, Saudi Arabia at 6weeks of gestations

Symptoms of lower abdominal pain and vaginal spotting, Current Pregnancy was induction of ovulation

There was no history suggestive of any major medical or surgical illness in past. Upon Presentation her Vital signs were stable, per abdominal examination: there was no tenderness or rebound tenderness ,vaginal examination: there was no Cervical Motion Tenderness. Her investigations showed: BHCG of 13231 ,other investigations were within normal.

 transvaginal scan showed:Right-Adnexa mass size 5.4x 4. 1cm viable twin pregnancy with two yolk sac and tow cardiac activity
For which patient was taken for Emergency Laparoscopic salpingectomy. 

Intraoperatively :there was moderate hemoperitoneum, Right sided Salpingectomy was done. The patient did well postoperatively and was discharged on 3rd day. 

The histopathological examinations Gonfirmed the Diagnosis (fallopian tube with intraluminal chronic villi and fetal tissue )

 

Discussion:

Several factors are increased the risk of ectopic pregnancy. 

Pelvic inflammatory disease is associated with the greatest increase in risk, but other associated factors include operative trauma, congenital anomalies, tumors, adhesions, and advancing maternal age. 

This case has several differences from other cases of unilateral live twin tubal pregnancies. 

First, the patient conceived after ovulation induction only whereas most cases were associated with ART and other risk factors.

Second, each fetus in the twin pregnancy had a yolk sac and cardiac activity

 Patient presented with high level of BHCG , that may raise the concern of heterotopic pregnancy or twins pregnancy which might be overlooked as singleton viable pregnancy.

 

Conclusions:

Viable ectopic pregnancy is a life-threatening with challenging diagnosis, by reporting such cases it will raise the knowledge of possible twins ectopic pregnancy in high level BHCG then it may help considering appropriate intervention and follow up accordingly.