Second trimester broad ligament ectopic pregnancy: a case report

• Published in: Journal of surgical case reports Vol. 2024; no. 2; p. rjae084
• Main Authors: Lugata, John, Mrosso, Onesmo, Mwidibo, Yusuph, Batchu, Nasra, Mchome, Bariki, Mbise, Fredrick B
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 03-02-2024
• Subjects: ectopic pregnancy; broad ligament; salpingectomy; emergency laparotomy; low resource setting
• ISSN: 2042-8812; 2042-8812
• DOI: 10.1093/jscr/rjae084

Abstract
An ectopic pregnancy occurs when the fertilized egg is implanted and develops outside the endometrium, i.e. in the fallopian tubes, cervix, ovary, or abdomen. It commonly presents with a history of amenorrhoea, lower abdominal pain, and slight vaginal bleeding. The fallopian tube is the most typical location for ectopic pregnancy. Two percent of reported pregnancies are ectopic pregnancy. Ectopic pregnancy remains a public health threat for women in reproductive age, and a major cause of maternal mortalities in the first trimester. In East Africa, these reports are limited, despite a great need for documentation addressing key considerations for diagnosis and management of ectopic pregnancy in these resource limited settings. In this case study, we report on 26-years-old female Gravida 5 Para 4 Living 4, who reported history of amenorrhoea for 3 months complaining of slight per vagina bleeding and lower abdominal pain for 5 days more marked at left iliac region along with generalized weakness for 2 weeks. Her vitals were stable. Pelvic ultrasound revealed empty uterus and live fetus at the left adnexa corresponding to 14 weeks 6 days with minimal free fluid in the Douglas Cul-de-sac. The patient’s final diagnosis was live extra-uterine pregnancy at 14 weeks 6 days that was managed by emergency laparotomy with salpingectomy. The patient recovered completely after surgery and was discharged in a stable condition. Ectopic pregnancy still remains one of the major causes of maternal morbidity and mortality. Early diagnosis and referral in hemodynamically state along with use of minimal access surgery or management can change the scenario of ectopic pregnancy in the developing world. Late attendance to first visit clinics is still a major concern in low resource limited settings as this could have been picked early and intervened.
Key message: Management of broad ligament ectopic pregnancy in the second trimester is still challenging especially in low resource settings where the clients do not attend clinics and because of unavailability of ultrasound machines to diagnose it.