Advanced tubal ectopic pregnancy of 19 weeks gestation: case report and review of the literature

Abstract

Ectopic pregnancy is a condition in which the fertilized ovum is impacted anywhere other than the uterine cavity, these sites may be uterine tubes, cervix, ovary and abdomen. Ectopic implantation in the uterine tubes occurs up to 98%. The distribution according to its location is: 78% ampullary, 12% isthmic, 5% fibrous, 2-3% interstitial, 1% ovarian, 1-2% abdominal, and more rare in cervix with 0.5%. Ectopic pregnancy occurs 1.2 to 2% of pregnancies, with an associated mortality of 0.5 deaths per 1000 pregnancies. There are multiple risk factors for an ectopic pregnancy, among the most frequent are: women with pelvic inflammatory disease (salpingitis) conditioned mainly by Chlamydia trachomatis and Neisseria gonorrhea, anatomical abnormalities of the tubes, previous surgery in them (including sterilization), masses extrinsic tumors that compress them, endometriosis, zygote anomalies, endocrinopathies (corpus luteum deficiency in late ovulation), use of intrauterine devices, previous ectopic pregnancy (as a result of surgical treatment or due to persistence of the original risk factor), contraceptive users with gestagens in low doses, assisted reproduction techniques, smokers, secondary adhesions to surgical interventions on the uterus, ovaries, and other pelvic or abdominal organs, exposure of the uterus to diethylstilbestrol, among others. The objective of this case is to describe an advanced tubal ectopic pregnancy. The following case report is about a 24-year-old patient with a pregnancy of 19 weeks of gestation by first-trimester ultrasound and a history of recent laparoscopic cholecystectomy secondary to biliary lithiasis. He is in the first trimester of normo-evolutive and without symptoms. Authors present to the emergency department with a 24-hour abdominal pain syndrome that requires exploratory laparotomy and right salpingo-oophorectomy due to the presence of ruptured tubal ectopic pregnancy with average fetometry of 19 weeks of gestation. The patient is discharged after an adequate clinical evolution.