Broad ligament ectopic pregnancy: a dilemma to diagnose
Keywords:Broad ligament, Ectopic pregnancy, Laparotomy
Broad ligament ectopic pregnancy is a rare and serious form of extrauterine pregnancy with a high risk of maternal mortality. There are no specific clinical features. Ultrasonography may help in diagnosis but definitive diagnosis is made only during surgery. A 20-year-old woman with previous 2 abortions presented with acute abdomen. She had no history of amenorrhoea but there was history of two episodes of bleeding in the last month at an interval of 14 days, each episode lasting for two-three days. The last episode of bleeding was 10 days back. Her urine pregnancy test was done and it was positive. There was marked abdominal tenderness with guarding and rigidity. Per vaginal examination revealed marked tenderness in the right fornix and cervical motion tenderness, uterus size could not be assessed due to tenderness. It was diagnosed as a case of ruptured ectopic pregnancy. Since she was haemodynamically unstable, emergency laparotomy was done. She had a right sided broad ligament ectopic pregnancy which had ruptured. The tissue was completely removed and haemostatic sutures were taken. High index of clinical suspicion, early diagnosis and prompt surgery is the key to management.
Bobyer J, Coste J, Fernandez H, Pouly JL, JobSpira N. Sites of ectopic pregnancy: a 10 Year population based study of 1800 cases. Hum Reprod. 2008;17:3224-30.
Phupong V, Lertkhachonsuk R, Triratanachat S, Sueblinvong T. Pregnancy in the broad ligament. Arch Gynecol Obstet. 2003;268:233-5.
Chia KV, Fayle RJS, Ferriman E. Intraligamentary pregnancy. J Obstet Gynaecol. 1993;13:254.
Alto WA. Abdominal pregnancy. Am Fam Physician. 1990;41:209-14.
Cordero DR, Adra A, Yasin S, O'Sullivan MJ. Intraligamentary pregnancy. Obstet Gynecol Surv. 1994;49:206.
Paterson WG, Grant KA. Advanced intraligamentous pregnancy. Report of a case, review of the literature and a discussion of the biological implications. Obstet Gynecol Surv. 1975;30:715-26.
Vierhout ME, Wallenburg HC. Intraligamentary pregnancy resulting in a live infant. Am J Obstet Gynecol. 1985;152:878-9.
Hallatt JG, Grove JA. Abdominal pregnancy: a study of twenty-one consecutive cases. Am J Obstet Gynecol. 1985;152:444-9.
Malian V, Lee JH. MR imaging and MR angiography of abdominal pregnancy with placental infarction. AJR Am J Roentgenol. 2001;177:1305-6.
Pisarka MD, Casson PR, Moise KJ, Di Maio DJ, Buster JE, Carson SA. Heterotropic abdominal pregnancy treated at laparoscopy. Fertil Steril. 1998;70:159-60.