Ruptured interstitial pregnancy: a case report of a sudden maternal death in the late second trimester from a rare cause

Abstract

Introduction: Interstitial pregnancy is a rare type of tubal ectopic pregnancy that occurs when implantation takes place in the interstitial segment of the fallopian tube. It remains one of the most difficult gestations to diagnose clinically and sonographically, hence a higher risk of rupture and catastrophic haemorrhage because of delayed diagnosis as the gestation progresses. We report a case of sudden maternal death from a ruptured interstitial pregnancy involving a woman at 27 weeks of pregnancy who was mistakenly thought to have a normal intrauterine pregnancy antenatally. Case description: A 40-year-old woman, normally conceived gravida 7, para 4, abortus 2 at 25 weeks of pregnancy by date, was dead on arrival at the hospital after experiencing sudden abdominal pain. A forensic autopsy revealed more than 2100 ml of hemoperitoneum. The uterine cavity was empty, and the right uterine fundus had an asymmetric cystic bulge found to be a ruptured interstitial pregnancy with a 27-week-old male fetus. Discussion and conclusion: The pathology of interstitial pregnancy and the distinction between this entity and the similar but distinct angular and cornual pregnancies will be described. This case report highlights a type of ectopic pregnancy rarely encountered in forensic pathology practice.