Tubo-Ovarian (Adnexal) Ectopic Gravidae: Comparative Analysis of 2 Cases

Abstract

Ectopic pregnancy occurs as a result of conceptus external to the endometrial cavity. It is a major cause of maternal mortality. Published case notes on this phenomenon fails to make accurate diagnosis of tubal conceptus. Incidence of ectopic pregnancy averages about 2.2% of all gravidae and is a leading cause of female mortality globally. A 30-year-old nulliparous woman registered at Kampala International University Teaching Hospital, Uganda with complain of upper pelvic pain on the right groin and iliac region for 4 days and amenorrhea for 6 weeks. Pelvic ultrasound showed right unruptured tubo-ovarian pregnancy with a fetal pole corresponding to 7 weeks + 1 day gestational age. Eight weeks later the pregnancy resulted in a missed abortion. A second (asymptomatic) ectopic case in a woman of reproductive age is reported. Incidental sonographic finding confirmed an adnexal mass containing a yolk sac coupled with high levels of beta-Human Chorionic Gonadotropin (β-hCG) in blood and urine; this in sexually active females of pubertal age is a positive ectopic gravida except proven otherwise. It was 6 weeks + 1 day gestational age and later terminated by elective surgery. Both cases were compared with normal intra-uterine pregnancy of 8weeks + 5days gestational age.  It should be noted that past uterine surgical operation may ‘alter’ uterine physiologic environment to increase the likelihood of an ectopic pregnancy. Tubal-Ring Sign in tubal gravidae is observed by a roundish hyperechoic ring surrounding the extra uterine gestational sac.