Case of post tubectomy tubal partial molar pregnancy

Abstract

A 34 year old lady reported to casualty OPD with complaints of pain abdomen of one day's duration. She gave H/O irregular menstrual periods and had her last menstrual period one month back. Obstetric history -P2L2A2. MTP and abdominal tubectomy done 7 years back. On per abdominal examination, there was tenderness all over abdomen. Patient was admitted with provisional diagnosis of UTI with APD. Antibiotics and other supportive measures were started. Relevant investigations were ordered for. Patient was referred to Gynaecologist for C/O pain lower abdomen and irregular menstrual periods. On per abdominal examination done by Gynaecologist, there was mild rigidity over right side of umbilical region. Urine pregnancy test was weakly positive. Ultrasound revealed mobile internal echoes in urinary bladder, minimal fluid in endometrial cavity and Pouch of Douglas. Serum Beta HCG was sent. Patient's general condition remained stable. Review scan done on next day revealed features suggestive of right adnexal ectopic gestation with minimal fluid in pelvis. It was decided to take her up for laparotomy. Abdomen was opened by Pfannesteil incision. Omentum was partially adherent to parietal peritoneum. Blood clot with some tissue (? Products of conception) was seen adjacent to fimbria of right fallopian tube. Same removed along with right sided salpingooopherectomy and left sided tubectomy. Beta hCG levels after surgery showed decreasing trend and remained normal when done 70 days after surgery. Histopathology report of right fallopian tube along with some tissue fragments was suggestive of Partial hydatidiform mole.