Abstract
Interstitial and cornual ectopic pregnancies are rare forms of ectopic with high mortality rate. As such, they pose significant challenges in diagnosis, treatment, and follow up.
This patient was a 42 y/o female G2P1001 at 25+3 weeks gestational age who presented from an outside hospital after an episode of sudden onset abdominal pain with syncope. She was noted to have hypotension, tachycardia, lactic acidosis, and peritoneal free fluid. Physical exam was significant for peritoneal signs with abdominal guarding and rebound. Her pregnancy was complicated by advanced maternal age, THC use, and late presentation for prenatal care in the second trimester. While she had no obstetrical complaints on admission, bedside ultrasound was done and showed viable infant in breech position with anhydramnios and free fluid in the abdomen. Fetal heart tones were category 2 with periods of minimal variability and intermittent variable and late decelerations. Given her clinical picture, she was consented for exploratory laparotomy and possible cesarean section and was taken to the OR by both Obstetrics and Trauma Surgery with NICU on standby. Upon entry to the abdomen, 2 liters of hemoperitoneum was evacuated, and visualization of the uterus revealed active bleeding from a right cornual rupture which extended into the isthmus of the right fallopian tube. The infant was delivered breech via classical cesarean section and handed off to NICU staff. The hysterotomy and cornual rupture were then repaired, including removal of the right fallopian tube, with good hemostasis noted. Trauma Surgery then explored the abdomen, with no further pathology or sources of bleeding noted. The patient’s post-operative course was complicated by post-op ileus, which resolved after 24 hours, and gestational hypertension. She was discharged home on post op day 4 in good condition. The infant’s NICU course was complicated by intraventricular hemorrhage, GERD, chronic lung disease with mild pulmonary hypertension, and retinopathy of prematurity. She was eventually transferred to another facility on day of life 130 due to worsening respiratory status and concern for ventilator acquired pneumonia.
Interstitial and cornual ectopic pregnancies are extremely difficult to diagnose and this difficulty only increases as the pregnancy progresses. When these ectopics evade detection into the second or third trimester, rupture can lead to life threatening hemorrhage due to the highly vascularized state of the uterus. This case highlights the importance of early and thorough dating ultrasounds.
Original language | American English |
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Journal | Default journal |
State | Published - Apr 30 2021 |
Disciplines
- Medical Education
- Obstetrics and Gynecology