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J Cases Obstet Gynecol, 2016;3(3):77-79
Journal of Cases in
Ob s te tri cs & G yn e co l o g y
Case Report
Spontaneous bilateral tubal pregnancies: A two staged presentation
Fouzia Memon1,*, Mohamed Matar1
1North Cumbria University Hospital, Carlisle, United Kingdom
Abstract
Spontaneous bilateral tubal pregnancy is an uncommon gynaecological event. It has an estimated incidence of 1 in 725 to 1 in 1580 ec-
topic pregnancies. The exact cause remains unknown and they are usually diagnosed at the time of surgery. It is an important cause of first tri-
mester maternal mortality and significantly affects future fertility. We report an unusual case of spontaneous bilateral tubal pregnan-
cy. At initial presentation the patient was clinically stable and treated with laparoscopic right salpingectomy, she subsequently underwent
laparotomy with left salpingectomy three weeks later at a further admission in haemorrhagic shock and significant haemoperitioneum.
Key Words:
Spontaneous bilateral ectopic pregnancy, gynaecological emergency, haemorrhagic shock, laparoscopic salpingectomy
Introduction Case Presentation
Although the incidence of bilateral tubal pregnancy is A 25-year-old primigravida presented with a 6 week his-
higher in assisted reproduction technique (ART) induced tory of amenorrhoea, intermittent vaginal bleeding and low-
patients, it should always kept in mind among spontaneous er abdominal pain for the past 5 days. Urine pregnancy test
pregnancies also. The incidence of bilateral tubal pregnan- was positive. There were no obvious risk factors for ecto-
cy is on the increase due to increased availability and utili- pic pregnancy. She was hemodynamically stable. She was
zation of ART so early diagnosis and treatment is necessary mildly tender in the lower abdomen and there was bilateral
to limit complications. Both uterine cavity and bilateral adnexal tenderness with cervical excitation on pelvic exam-
adnexial areas should be examined during management of ination. Serum beta human chorionic gonadotrophin level
viable and non-viable pregnancies even for spontaneously was 1880IU/L and transvaginal pelvic ultrasound revealed
conceived pregnancies. There is a need for an agreed proto- an empty uterus with a 3.7 x 3.3 cm left adnexal mass sug-
col for appropriate management and follow up of such cases. gesting a left tubal ectopic pregnancy. The patient was coun-
selled about the possibility of ectopic pregnancy, its conse-
Article History: quences and treatment options. At diagnostic laparoscopy
Received: 19/11/2015 there was a right, rather than left, slow leaking fimbrial ec-
Accepted: 16/03/2016 topic pregnancy that was successfully managed by right sal-
pingectomy. Both ovaries appeared normal, although the left
*Correspondence: Dr. Fouzia Memon (Consultant Obstetrician and tube looked mildly oedematous. She was planned for follow
Gynaecologist) up in the early pregnancy assessment unit and a hysterosal-
Address: Cumberland Infirmary, Newtown Road, Carlisle CA2 7HY
Phone: 00447882674593 77
Email:[email protected]
Journal of Cases in Obstetrics & Gynecology
Journal of Cases in
Ob s te tri cs & G yn e co l o g y
Case Report
Spontaneous bilateral tubal pregnancies: A two staged presentation
Fouzia Memon1,*, Mohamed Matar1
1North Cumbria University Hospital, Carlisle, United Kingdom
Abstract
Spontaneous bilateral tubal pregnancy is an uncommon gynaecological event. It has an estimated incidence of 1 in 725 to 1 in 1580 ec-
topic pregnancies. The exact cause remains unknown and they are usually diagnosed at the time of surgery. It is an important cause of first tri-
mester maternal mortality and significantly affects future fertility. We report an unusual case of spontaneous bilateral tubal pregnan-
cy. At initial presentation the patient was clinically stable and treated with laparoscopic right salpingectomy, she subsequently underwent
laparotomy with left salpingectomy three weeks later at a further admission in haemorrhagic shock and significant haemoperitioneum.
Key Words:
Spontaneous bilateral ectopic pregnancy, gynaecological emergency, haemorrhagic shock, laparoscopic salpingectomy
Introduction Case Presentation
Although the incidence of bilateral tubal pregnancy is A 25-year-old primigravida presented with a 6 week his-
higher in assisted reproduction technique (ART) induced tory of amenorrhoea, intermittent vaginal bleeding and low-
patients, it should always kept in mind among spontaneous er abdominal pain for the past 5 days. Urine pregnancy test
pregnancies also. The incidence of bilateral tubal pregnan- was positive. There were no obvious risk factors for ecto-
cy is on the increase due to increased availability and utili- pic pregnancy. She was hemodynamically stable. She was
zation of ART so early diagnosis and treatment is necessary mildly tender in the lower abdomen and there was bilateral
to limit complications. Both uterine cavity and bilateral adnexal tenderness with cervical excitation on pelvic exam-
adnexial areas should be examined during management of ination. Serum beta human chorionic gonadotrophin level
viable and non-viable pregnancies even for spontaneously was 1880IU/L and transvaginal pelvic ultrasound revealed
conceived pregnancies. There is a need for an agreed proto- an empty uterus with a 3.7 x 3.3 cm left adnexal mass sug-
col for appropriate management and follow up of such cases. gesting a left tubal ectopic pregnancy. The patient was coun-
selled about the possibility of ectopic pregnancy, its conse-
Article History: quences and treatment options. At diagnostic laparoscopy
Received: 19/11/2015 there was a right, rather than left, slow leaking fimbrial ec-
Accepted: 16/03/2016 topic pregnancy that was successfully managed by right sal-
pingectomy. Both ovaries appeared normal, although the left
*Correspondence: Dr. Fouzia Memon (Consultant Obstetrician and tube looked mildly oedematous. She was planned for follow
Gynaecologist) up in the early pregnancy assessment unit and a hysterosal-
Address: Cumberland Infirmary, Newtown Road, Carlisle CA2 7HY
Phone: 00447882674593 77
Email:[email protected]
Journal of Cases in Obstetrics & Gynecology
