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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2011 October;170(5):373-8
Ectopic tubal pregnacy on second trimester
Teodoro M. C., Abruzzo S. R. M., Santonocito V. C., Tomaselli T. G., Zarbo R.
“Istituto di Patologia Ostetrica e Ginecologica” P.O. Santo Bambino, Azienda Ospedaliera Universitaria “Policlinico-Vittorio Emanuele”, Università degli Studi di Catania, Catania, Italia
Definition of ectopic pregnancy (EP) accounts for fertilized egg implantation outside the endometrial cavity. EP in recent years increased with an medium incidence rate from about 0.4% in the 1950 up to about 1.5-2% in the 2000 in the different western countries and this percentage still continues to increase. About 98% of all ectopic pregnancies are tubal and more than 80% of them occur in the ampullary portion. Classically, transvaginal sonography (TVS) and low serum beta human chorionic gonadotrophin (β-hCG) levels contribute to diagnose ectopic pregnancies at the 6th-7th weeks. The EP rarely progress beyond the first trimester still misdiagnosed. We report on a tubal ampullary pregnancy in the 15th week of gestation evolved in tubal rupture with subsequent hemoperitoneum and shock. The patient complained only for abdominal pain and she didn’t have any menses for 15 weeks. Patient referred that a diagnostic pelvic sonography, at home, showed a “normal evolution intrauterine pregnancy” with an amenorrhea related gestational age. However, a “not defined mass” coexisted, localized before the gestational sac; it was suggested as “necrosis mioma”. During hospital stay, fever and epigastric pain established, initial shock appeared and an emergency successful laparotomy was performed; a ruptured right fallopian tube from the ampullar portion and a well developed stillborn fetus measuring 12 cm (crown to heel) were evident. Ectopic pregnancy should be always considered in the differential diagnosis of acute abdomen in a fertile woman, even in advanced gestational weeks and in apparent normal evolution.