Bilateral Tubal Pregnancy Following Spontaneous Conception: A Case Report and Literature Review

Abstract

Ectopic tubal pregnancy (ETP) continues to be a serious health condition and the leading cause of maternal morbidity and mortality in early pregnancy. Its incidence has increased lately to reach 1.5-2% of all early pregnancies. Bilateral tubal pregnancy (BTP) is the rarest form of extra-uterine pregnancy. It is usually associated with infertility treatment, while spontaneous occurrence is exceptionally rare. The clinical presentation of BTP is unpredictable and the performance of currently available imaging modalities is unsatisfactory, rendering the diagnosis extremely difficult, mostly made during surgery. Herein, we present a case of a 39-year-old patient who presented with a disturbed ectopic pregnancy. Intra-operatively, a ruptured tubal pregnancy, together with another intact ETP in the contralateral tube, was encountered. Salpingectomy and salpingostomy were done respectively preserving the intact tube with uneventful recovery. This was followed by a review of recent literature on BTP. Definitive diagnosis of BTP continues to be made at surgery in spite of some improvement in preoperative detection. Meticulous examination by sonographers of the whole pelvis in early pregnancy should be the routine even in extra-uterine pregnancies. Gynecologists should explore contralateral tube while performing surgery on ETP. Furthermore, close surveillance with clinical, sonographic and serial serum beta-chain human chorionic gonadotropin, should be implemented for all ETP even following salpingectomy. J Clin Gynecol Obstet. 2020;9(3):60-69 doi: https://doi.org/10.14740/jcgo642