Abdominal Ectopic Pregnancy: Challenging Obstetrical Paradox in Series of Three Cases

Abstract

Abdominal Ectopic Pregnancy (AEP), a rare life-threatening obstetrical complication, is defined as ectopic implantation within the peritoneal cavity outside the uterus, tubes, ovaries, or intra-ligamentous locations. A series of three rare cases of early AEP is presented: (First case: a 32-year-old, gravida 2, para 1; Second case: a 31-year-old, gravida 3, para 2; and Third case: a 39-year-old gravida 4, para 2). All the cases were of early (<20 weeks) primary AEP and they all presented with acute abdomen, unstable vitals, and haemoperitoneum. The first case had omental implantation with a gestational sac of (3×3) cm and was diagnosed by strong clinical suspicion with intraoperative confirmation for the same, whereas the second and third cases had implantation on Pouch of Douglas (POD) and sigmoid colon respectively; and was diagnosed by sonography with intraoperative confirmation during laparotomy. All three cases were successfully managed by a multidisciplinary team approach, blood transfusions, and emergency laparotomy with complete removal of the placenta. They had a good postoperative recovery. The reports of histopathology of tissues retrieved peroperatively from the implantation sites showed chorionic villi which confirmed the product of conceptions. Presentation of this case series provides an opportunity to illustrate a rare variant of ectopic pregnancy with a challenging obstetric dilemma and to discuss the importance of strong clinical suspicion for such a grave maternal condition, on the part of the attending obstetrician, to make an early diagnosis and prompt treatment, so that maternal morbidity and mortality can be avoided.