Abstract
Background: Unilateral tubal twin pregnancies occur in approximately 1 of every 125,000 spontaneous pregnancies. Because of the paucity of data, little guidance for the appropriate management of a twin tubal ectopic pregnancy is available. Case Report: A 40-year-old female presented to the emergency department (ED) with a 2-day history of vaginal bleeding associated with lower abdominal pain. The patient was hemodynamically stable with signs of an acute abdomen. Pelvic examination elicited clinical findings consistent with potential ectopic pregnancy. Urine pregnancy test in the ED was positive. Serum beta-human chorionic gonadotropin was 23,359 mIU/mL, and transvaginal ultrasound showed findings concerning for a twin ectopic pregnancy. Diagnostic laparoscopy with right salpingostomy was successful, and the patient had an uncomplicated postoperative course. Conclusion: Healthcare providers should have a high index of clinical suspicion for ectopic pregnancies. Unilateral tubal twin ectopic pregnancies, while rare, can be adequately diagnosed with transvaginal ultrasound. Laparoscopic salpingostomy provides conservative and successful treatment of unilateral tubal twin gestation with short recovery time. Medical treatment with methotrexate has not been adequately studied in this clinical scenario, but further exploration of this management modality should be considered.
Highlights
Ectopic pregnancy accounts for approximately 1%-2%of first-trimester pregnancies and may be the cause of up to 6% of pregnancy-related deaths.[1]
Contraceptive methods overall decrease the risk of ectopic pregnancy by preventing all pregnancies, intrauterine devices (IUDs) may increase the risk.[1]
Detection of ectopic pregnancy has improved via urine/serum beta-human chorionic gonadotropin testing and transvaginal ultrasound, decreasing associated morbidity and mortality
Summary
Unilateral tubal twin pregnancies occur in approximately 1 of every 125,000 spontaneous pregnancies. Because of the paucity of data, little guidance for the appropriate management of a twin tubal ectopic pregnancy is available. Pelvic examination elicited clinical findings consistent with potential ectopic pregnancy. Serum betahuman chorionic gonadotropin was 23,359 mIU/mL, and transvaginal ultrasound showed findings concerning for a twin ectopic pregnancy. Diagnostic laparoscopy with right salpingostomy was successful, and the patient had an uncomplicated postoperative course. Unilateral tubal twin ectopic pregnancies, while rare, can be adequately diagnosed with transvaginal ultrasound. Laparoscopic salpingostomy provides conservative and successful treatment of unilateral tubal twin gestation with short recovery time. Medical treatment with methotrexate has not been adequately studied in this clinical scenario, but further exploration of this management modality should be considered
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
