Advanced ectopic pregnancy
Ahmad Ummarah, Sana Yasmin, Afridi Gulsanga, Hawe Jeremy Anthony
Corniche Hospital, Abu Dhabi. UAE

Objective:
To discuss the challenges in diagnosis and management of a rare case of an advance ectopic pregnancy
Case history:
A 36 years old nulliparous was referred to Corniche hospital with due to failed medical management of miscarriage at 18 weeks gestation. There was also suspicion of bicornuate uterus on her previous scans in referring hospital.
On USS at Corniche Hospital:
The uterus was normal in shape and empty. Right vary was normal. Left ovary could not be seen. A large non viable ectopic pregnancy was seen in left adnexa. The exact location could not be determined. Differential diagnosis was of
interstitial pregnancy, pregnancy in rudimentary horn or abdominal pregnancy. A pelvic MRI was done, which was not helpful. Patient underwent diagnostic laparoscopy which was suggestive of the large ectopic mass in broad
ligament. In view of high risk for bleeding and lack of IR support, further surgery to excise the mass was not undertaken and she was referred to Oncology centre. A CT angiogram revealed highly vascular mass with blood supply directly
from left internal iliac. She underwent embolization followed by laparotomy and excision of the ectopic pregnancy.
At surgery impression was of an ovarian pregnancy.
Reason for delayed diagnosis:
• First trimester USS showed fluid in cavity which was misdiagnosed to be intrauterine pregnancy.
•Ectopic was suspected by sonographer at 12 weeks however it was overruled by the Radiologist reviewing images and signing the scan. It was concluded to be a bicoruante uterus with an intrauterine pregnancy.