Spontaneous pregnancy following post in vitro fertilization ruptured tubal ectopic pregnancy

Abstract

Ectopic pregnancy (EP) is a dramatic life threatening event in a woman’s reproductive life, especially after a long, expensive and difficult course of treatment for infertility. EP accounts around 1–2% of all natural conceptions, and this prevalence increases following assisted reproductive techniques, to range between 2.1% and 8.6% and it can reach up to 11% in women with tubal factors infertility history. A 32 year old female, primigravida presented at emergency department of Apollo Hospitals, Ahmedabad with complaints of amenorrhoea 2 months, severe pain abdomen associated with vomiting, difficulty in breathing and bleeding per vagina on and off. She was a case of primary infertility with polycystic ovary syndrome (PCOS) who had conceived after difficulty with in vitro fertilization (IVF), resulted in ruptured right tubal ectopic pregnancy. She underwent exploratory laparotomy followed by removal of right ectopic pregnancy, right salpingectomy and peritoneal lavage. Early diagnosis, timely intervention and prompt surgical management could save the patient’s life. Later on she conceived spontaneously and had an eventful and complicated pregnancy. She presented at 35 weeks of pregnancy with preterm labour pain and underwent emergency caesarean section for fetal distress. She delivered a healthy male child and had a successful obstetric outcome. Diagnosis of ruptured tubal ectopic pregnancy is made based on patient’s history, clinical acumen, serum beta human chorionic gonadotropin (hCG) levels and pelvic ultrasound. Ectopic pregnancy should be suspected in patients with an adnexal mass even in absence of risk factors. Clinicians must be alert to the fact that assisted reproductive techniques as a treatment for infertility can result into ectopic pregnancy. This case highlights the fact that patient who underwent IVF treatment resulting in ruptured tubal ectopic pregnancy can have spontaneous conception and a successful obstetric outcome.