1229 Spontaneous Heterotopic Pregnancy Resulting in Tubal Rupture and Complete Spontaneous Abortion: A Case Report in Tiko, Cameroon

Abstract

Abstract Aim To present a case report of the management and early outcome of a first-trimester spontaneous heterotopic pregnancy (HP) in a low-resource setting. Method This piece of work has been reported according to the Surgical CAse REport guidelines. Results A 24years old G2P0010 at 11 weeks of gestation with a history of one induced abortion and a family history of twin pregnancies presented with an acute abdomen, associated with vaginal spotting in an afebrile context. Recurrence of the vaginal spotting and increase in the severity of the abdominal pain prompted an obstetrical ultrasound which showed retained products of conception, as well as the presence of a left adnexal mass suggestive of an extrauterine gestational sac at approximately 6 weeks of gestation. There was spontaneous expulsion of retained products of conception. The deterioration of the haemodynamic stability of the patient prompted an emergency laparotomy to be done after a repeat ultrasound suggestive of a ruptured left ectopic pregnancy (EP), and optimisation of the patient. Evacuation of 700ml of dark red haemoperitoneum and salpingectomy was done. The patient was transfused, post-salpingectomy counselling done and was discharged on oral analgesics, blood tonics and antibiotics on day 6 Post–operation. Conclusions HP should be suspected in first trimester bleedings especially if associated with an acute abdomen. An ultrasound should be performed on all patients presenting with clinical manifestations of abortion to help in the early diagnosis and treatment of a concurrent EP. Laparotomy is relatively safe in the context of abortion and shock secondary to haemoperitoneum.