Ruptured Interstitial Ectopic Pregnancy at 18 Weeks: How Failure of Early Detection Resulted in a Maternal Near-miss

Abstract

Interstitial ectopic pregnancy occurs when a gestational sac implants within the interstitial portion of the Fallopian tube. It is an uncommon and dangerous type of ectopic pregnancy with high morbidity and mortality. Rupture of interstitial ectopic pregnancy usually leads to life-threatening hemorrhage. This case report illustrates how failure of early detection of interstitial ectopic pregnancy resulted in a maternal near-miss and calls for the need for increased awareness and high index of suspicion among sonographers and clinicians. A case of a 24-year-old gravida two para zero, one previous ectopic pregnancy (G2P01EP) was brought into our facility with generalized abdominal pain and hemorrhagic shock. She had a previous history of left salpingectomy for a ruptured tubal ectopic pregnancy four years earlier at a secondary health care facility. Emergency laparotomy after aggressive resuscitation revealed ruptured interstitial ectopic pregnancy with massive hemoperitoneum and a dead fetus. Wedge resection of the right cornua along with the Fallopian tube was done. Diagnosis of interstitial ectopic pregnancy is challenging due to its rarity and location in the intrauterine portion of the Fallopian tube. Ultrasonographic diagnosis in early pregnancy is key. Awareness creation and a high index of suspicion is required among sonographers and clinicians to prevent needless morbidity and mortality.