Ectopic pregnancy in the ampulla of the fallopian tube at 16 gestational weeks: lessons from a case report

It is uncommon to find ampullary tubal pregnancy in the second trimester.

A 35-year-old G4P3 at 16 gestational weeks presented with a day history of sudden severe lower abdominal pain and no vaginal bleeding. The patient had a normal pulse of 82/minutes, haemoglobin concentration of 6.3 g/dl and ultrasonography showed an empty uterus with an alive fetus in the right adnexa. She was provisionally diagnosed to have an abdominal pregnancy.

The patient had an emergency laparotomy where 2.2 L of haemoperitoneum and a slow-leaking right ampullary tubal pregnancy were found. Right total salpingectomy was performed and she had an uncomplicated post-operative follow-up. Histology of the lesion confirmed tubal pregnancy.

The growth of a pregnancy in the ampulla beyond the first trimester is possibly due to increased thickness and or distensibility of the fallopian tube. A tubal pregnancy may present with a normal pulse despite significant haemorrhage.