Live extrauterine ectopic pregnancy

Case contributed by Dr Ariel Dahan

Presentation

Confirm location of pregnancy.

Patient Data

Age: 30 years
Gender: Female

An amniotic sac containing a mobile, live foetus with an 11 week, 3 day gestational age on ultrasound is present within the right adnexa. The gestational sac is separate to the uterus which is anteverted and retroflexed and demonstrates a decidual response of the endometrium.

The right ovary is separate to the gestational sac and there is small bowel intervening between the uterus and the gestational sac.  

No free fluid within the Pouch of Douglas to suggest rupture.

Further assessment with MRI upon transfer to tertiary center

A small, 16 mm, right-sided rudimentary uterine horn is separate from the native cavity, best appreciated on the axial uterus plane images.

The ectopic pregnancy is posterior and separate to the uterus and rudimentary right horn. The right ovary is inferolateral to the pregnancy. No surrounding hematoma or free fluid. 

Previous lower uterine segment cesarean section scar. Normal endometrium. Trace free fluid in the pelvis. 

Case Discussion

The patient went on to have surgical removal of the pregnancy and was later able to carry an intrauterine pregnancy to term two years later.

A nice example of a live extrauterine ectopic pregnancy, in this case in the right adnexa. Some have used the phrase “abdominal ectopic pregnancy” as an equivalent to extrauterine ectopic pregnancy in cases that have reached 18 weeks of gestation, despite not strictly demonstrating placental implantation within the peritoneal cavity 1.

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