Spontaneous Bilateral Tubal Ectopic Pregnancy

Abstract

Background: Bilateral tubal pregnancy in absence of preceding induction of ovulation is a rare event, with an estimated incidence of 1/200,000 uterine pregnancies and 1/725–1/1580 ectopic pregnancies. These conditions are usually diagnosed at the time of surgery. This article reports a case of a spontaneous bilateral intact tubal multiple pregnancy associated with an ovarian cyst that was diagnosed intraoperatively and addressed with two different surgical techniques. Case: A 35-year-old woman, gravida 7, para 5+1, presented with a history of 8 weeks' amenorrhoea and intermittent vaginal bleeding; she also had mild lower abdominal pain of 1 week's duration. A urine pregnancy test taken on the day of her admission positive. This patient's abdomen was tender on palpation with a positive rebound and guarding. On pelvic examination, there was mild spotting and cervical motion tenderness were noted. A pelvic ultrasound reveled an echogenic mass lesion in the right adnexae with an ovarian cyst in the left side. A laparotomy reveled a bilateral ectopic tubal pregnancy with an ovarian cyst. Salpingectomy was performed in the unruptured right tube, and the unruptured ectopic pregnancy in the left tube was removed through salpingostomy. Results: This patient's postoperative follow-up was unevenful and histologic testing of the specimens that had been excised confirmed the diagnosis. Conclusions: Despite being rare, bilateral spontaneous ectopic pregnancy should be suspected regardless of the presence or absence of risk factors this condition, such as the use of assisted reproduction techniques. Because of its rarity, diagnosis of spontaneous ectopic pregnancy is difficult, but once the condition is diagnosed, it can be treated surgically. (J GYNECOL SURG 29:321)