EC Gynaecology

Tubal abortion is an uncommon occurrence following a tubal ectopic pregnancy, which can have life threatening implication such as massive haemoperitoneum. A high index of suspicion is required to make a diagnosis, in addition to corroborating clinical, laboratory, ultrasound, laparoscopic and histological findings.

This is a case of a lady who presented with worsening abdominal pain and a positive pregnancy test. Following a bedside pelvic scan, which revealed significant haemoperitoneum and no evidence of an intrauterine or extrauterine gestational sac, she had a diagnostic laparoscopy, confirming massive haemoperitoneum and no evidence of an ectopic pregnancy. On the second day post op, abdominal pain worsened and a drop in haemoglobin was noticed. A repeat scan revealed further haemoperitoneum. She underwent a second diagnostic laparoscopy which revealed massive haemoperitoneum and an Omental complex of blood and suspected trophoblastic tissue, which was confirmed on histopathology. There was a decline in the trend of serum BHCG, with a negative urine Pregnancy test 3 weeks after the second laparoscopy.

Tubal abortion is a diagnosis of exclusion. Ultrasound is of little to no importance in making a diagnosis but is useful in confirming haemoperitoneum. Diagnostic laparoscopy is vital in examining the peritoneal cavity and evacuating haemoperitoneum. Expectant management is usually possible in the face of declining serum hCG levels avoiding surgical or medical intervention.

 Keywords: Ectopic; Tubal Abortion; Laparoscopy; Serum bHCG

1. Centre for Maternal and Child Enquiries (CMACE). “Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006-08. The eighth report on Confidential Enquiries into Maternal Deaths in the United Kingdom”. BJOG: An International Journal of Obstetrics and Gynaecology1 (2011): 1-203.
2. Sivalingam Vanitha N., et al. “Diagnosis and management of ectopic pregnancy”. The Journal of Family Planning and Reproductive Health Care4 (2011): 231-240.
3. Thornton J. “Women are at serious risk of harm from late diagnosis of ectopic pregnancy”. British Medical Journal 368 (2020): m924.
4. Callahan R., et al. “Ectopic pregnancy with use of progestin-only injectables and contraceptive implants: a systematic review”. Contraception6 (2015): 514-522.
5. Chirculescu B., et al. “Complete tubal abortion: A rare form of ectopic pregnancy”. Chirurgia (Bucharest)1 (2017): 68-71.
6. Tulandi T. “Ectopic pregnancy: Clinical manifestations and diagnosis” (2016).
7. Porwal S and Gupta R. “Secondary abdominal pregnancy following tubal abortion: a unique case”. Journal of Pharmaceutical and Biomedical Sciences 6 (2012): 1-2.