Ectopic pregnancy and the diagnostic challenges in the multi-fibroid uterus
S Manji1, S Balogun1, A Unipan1, A Coker1
1 Queen’s Hospital Romford
Case study:
•Background:
•37 year old, P0, 13/40
•Ethnicity: Black African
•Referral to EPAU from antenatal scan with suspicion of ectopic pregnancy
•Imaging:
•Repeat ultrasound: large, multi-fibroid uterus
•Live fetus in right adnexa consistent with 13w1d gestation
•Significant hemoperitoneum
•Clinical analysis:
•Arrived to the EPAU with stable observations
•Soon developed more pain and became haemodynamically unstable requiring fluid resuscitation
•Initial Haemoglobin level 66 g/L
•Emergency laparoscopy converted to laparotomy due to limited access to adnexa and haemoperitoneum secondary to ruptured ectopic pregnancy
•Right salpingectomy performed, estimated total blood loss 2500ml
•Required 4 units red blood cells and 2 units packed platelets for fluid replacement
•Post-operative and follow-up
•Day 2: episode of desaturation and collapse
•CTPA: bilateral large saddle pulmonary embolism with right heart strain Therapeutic anticoagulation initiated with Haematology team
•Day 8: stable for discharge with follow-up in the community
Discussion:
•Identifying a correctly sited pregnancy in the presence of a multi-fibroid uterus can be challenging due to obscured imaging.
•Ectopic pregnancies presenting at advanced gestations are rare and are often associated with abdominal or uterine implantation.
•These cases present greater surgical risks with morbidity and mortality.
Conclusion:
It is important to ensure a systematic approach when performing early pregnancy scans and if a clinician is unsure of the pregnancy implantation site, should seek a second senior opinion. Early recognition and prompt intervention are crucial to prevent catastrophic outcomes in ectopic pregnancies presenting at advanced gestations.
