Second Trimester Tubal Pregnancy: Management of an Unusual Case at 16 Weeks

 

Abstract :

Introduction: Tubal ectopic pregnancies typically rupture in the first trimester. Advanced tubal pregnancies progressing beyond the first trimester are exceptionally rare due to the anatomical constraints of the fallopian tube.

Case presentation:

28-year-old attended emergency with severe abdominal pain. Ultrasound showed massive hemoperitoneum, empty uterus with a live fetus of parameters corresponding to 16 weeks gestation in left side of the pelvis. Emergency laparotomy was performed and confirmed a large left tubal pregnancy, left salpingectomy was carried out. The postoperative course was uneventful.

Discussion: This case represents one of the most advanced tubal pregnancies reported in literature. The absence of early rupture may be attributed to unusual tubal elasticity or atypical trophoblastic invasion. The case highlights the diagnostic challenges in advanced tubal pregnancies, where initial imaging may be misleading.

Conclusion: This rare presentation emphasizes that tubal pregnancy should remain in the differential diagnosis beyond the first trimester. It underscores the importance of comprehensive early prenatal care and detailed ultra-sonographic assessment during pregnancy.