Tubal Stump Ectopic Pregnancy Following Two Previous Ectopic Pregnancies

Abstract

We present the case of a 36-year-old G4P1031 Caucasian female with a history of three consecutive ectopic pregnancies following a successful cesarean section of her first child. The first ectopic pregnancy was located on the left fallopian tube and was managed with methotrexate treatment with inadequate beta-human chorionic gonadotropin decline leading to a therapeutic salpingectomy. The second was located in the right adnexa and was managed medically with methotrexate. The third was a ruptured left-sided fallopian stump ectopic pregnancy 24 days following an embryo transfer and was managed surgically via emergency laparoscopy resulting in removal of the left fallopian tube remnants. Ectopic pregnancy is an obstetrical emergency and the leading cause of maternal morbidity and mortality in the first trimester. Women with a history of prior ectopic pregnancy have an approximately eightfold increase in risk for a future ectopic pregnancy and there remains a gap in knowledge regarding prevention of recurrent ectopic pregnancies. Ectopic pregnancies are rare, but multiple recurrent ectopic pregnancies are much more rare and through this case we shed light on the importance of appropriate individualized discussions regarding risks of future pregnancy following a previous ectopic pregnancy. Furthermore, tubal stump ectopic pregnancies pose a surgical challenge as an ectopic pregnancy not visualized on ultrasound can lead to erroneous excision of the unaffected contralateral tube intraoperatively due to expectations that an ectopic pregnancy would not likely recur on the side that is surgically absent due to prior salpingectomy. We also highlight the necessity for investigation of strategies for management of pregnancies following a prior ectopic pregnancy and preventing recurrent ectopic pregnancies.

J Clin Gynecol Obstet. 2022;11(2):47-52
doi: https://doi.org/10.14740/jcgo798