Asymptomatic patient with an ectopic pregnancy @ 11 weeks

Purpose: Ectopic pregnancy occurs in around 1 – 3% of all pregnancies and is still the most common cause of first trimester maternal death accounting for 73% of early pregnancy mortality. The incidence of ectopic pregnancy has increased markedly over the last three decades. Cases may be mislead by asymptomatic patients and the absent of common clinical findings.

Material and methods: Case report, literature review.

Results: A 28-year-old woman was referred with a tubal ectopic pregnancy @ 11 weeks of gestation detected at her first visit for antenatal care. On admission vital signs were stable and no abdominal guarding or rebound tenderness was present. She had no history of a previous ectopic pregnancy.

Transvaginal ultrasound scan revealed a vital right-sided tubal ectopic pregnancy with a CRL of 45 mm (Fig. 1) and an empty uterus with a thickened endometrium (Fig. 2).

Laparoscopic intervention confirmed ultrasound findings (Fig. 3). Despite the large fetus the fallopian tube was not ruptured. The removal of the fetal body (Fig. 4) was followed by salpingectomy.

Fig. 1

Conclusions: Three findings can be drawn from this case:

• Patient with an advanced tubal ectopic pregnancy can present asymptomatic and common clinical findings can be absent leading to misdiagnosis.

• Advanced tubal ectopic pregnancy can be managed laparoscopically.

• The mucosal layer of the fallopian tubes is capable to provide an environment for implantation and supply for fetal growth up to 11. Weeks of gestation.