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Published on: September 12, 2025
Delayed Vaginal Cuff Ectopic Pregnancy Following Hysterectomy: A Case Report
Emmanuel Nshimiyumuremyi1, Dawit Worku Kassa1, Bagambe Patrick1
1Department of Obstetrics and Gynecology, Kigali University Teaching Hospital (KUTH), Kigali City, Rwanda.
Background:
Vaginal cuff ectopic pregnancy after hysterectomy is extremely rare and poses diagnostic challenges due to unusual anatomical implantation and low clinical suspicion. Delay in diagnosis may result in catastrophic hemorrhage.
Case Presentation:
A 30-year-old G7P5014 (gravida 7 para 5 1 miscarriage and 4 living children, one stillbirth because of uterine rupture) woman presented 10 months after total abdominal hysterectomy and right oophorectomy with nausea and dizziness. Transvaginal ultrasound revealed a live 8-week embryo. She initially declined surgery. Two days later, she returned with abdominal pain, hypotension (BP 90/70 mmHg), and tachycardia (HR 130 bpm). Repeat ultrasound showed intra-abdominal free fluid. Emergency laparotomy revealed 2.5-L hemoperitoneum and a gestational sac implanted on the vaginal cuff. The sac was excised, hemostasis secured, and the patient recovered well after transfusion.
Conclusion:
Clinicians should maintain high suspicion for ectopic pregnancy in reproductive-aged women with preserved ovaries, even after hysterectomy. Early diagnosis and urgent surgical intervention are essential to prevent mortality.
