Rapports de cas cliniques et médicaux

Interstitial Ectopic Pregnancy Rupture at 15 Weeks of Gestation in a Sudanese Patient: A Case Report and Literature Review

Abstract

Amgd Amar, Awad Osman, Osman A. H. Osman, Monzir Ahmed, Omar Dafallah, Maab Osman, Majida Ahmed, Ahmed Hassan and Mohamed Yahia

Interstitial ectopic pregnancy is rare and results in the embryo being implanted in the uterine tube's intramural region which is the most proximal part of the Fallopian tube inside the myometrium. 1-2% of pregnancies result in ectopic pregnancy and only 3-4% of ectopic pregnancies are interstitial. It has a significat risk of catastrophic hemorrhage from uterine rupture. The mortality rate for interstitial ectopic pregnancies is high, ranging between 2-2.5% with a rupture rate of about 15%. Therefore, it contributes significantly to maternal morbidity and mortality. 7–12 weeks is the typical gestational age at presentation and majority of interstitial ectopic pregnancies rupture before 12 weeks of gestation; however, our case report presented at 15 weeks of gestation. Here, we present a 32-year-old, gravida 11 para 5 plus 5 female. The gestational age was 15 weeks. She had a history of 5 previous spontaneous vaginal deliveries and 5 spontaneous first trimester miscarriages. She complained of pain in the epigastrium and lower abdomen, fainting and vomiting. There was no vaginal bleeding. Her examination revealed sever pallor, impaired conciosness, tenderness all over the abdomen with voluntary guarding, tachycardia at 130/min and blood pressure of 90/60. Serum beta-hCG test was positive. An ultrasound scan demonstrated an empty uterus with a non-viable fetus in the left adenexal region. She had significant free fluid throughout the abdomen with severe peritoneal effusion in the pouch of Douglas extending around the uterus and through the Morison's pouch. An emergency laparotomy was performed under general anesthesia. Intraoperatively a ruptured left interstitial ectopic pregnancy of 15 weeks gestation on the left aspect of the uterus was detected. A cornuostomy with left salpingectomy were performed. Haemoperitoneum was encountered and approximately 1500 ml of blood was evacuated from the abdomen. The patient was transfused with 6 units of blood. Post operation recovery was uneventful and she was discharged home on day 4 postoperatively. She was scheduled to have hysterosalpingography after the surgury to exclude uterine anomalies.