We have received
a woman complaining of lower abdominal pains and vaginal bleeding without
clots.
She had an U\S
done in another facility reading as follows: “features of intrauterine foetal
death at 13 weeks gestational age”.
We have believed
the report of the sonography and, because the foetus was big and the cervix was
closed, we have decided to ripen the cervix before with a misoprostol pessary
of 50 micrograms, followed by induction of labour with oxytocin.
The induction failed
and 12 hours after the cervix was still closed. We have therefore decided to
repeat the U/S and we have found the following:
1)
The uterus was empty and
regular with a very tiny haematometra.
2)
Behind the uterus there was a
complex mass looking like haematoma and measuring about 15 cm diameters.
3)
There was slight
hemoperitoneum.
4)
A dead foetus measuring about
50mm was seen at the lower part of the mass.
We have changed
the diagnosis into ectopic pregnancy and we have planned for an emergency
operation. After opening the abdomen we have seen a mild collection of blood in
the large peritoneal cavity. The right adnexus was occupied by a big mass which
had taken adhesions to the intestine. The uterus and the right tube were
normal, while it was not possible to see the right ovary.
We have
cautiously detached the adhesions and slowly we have been able to isolate and
remove a mass which contained a rotten placenta, the dead foetus and the
membranes. The mass was located deep into the Douglas pouch. The membranes were
in continuity with right ovary which looked nearly completely destroyed.
We then stopped
the bleeders, we washed the peritoneum with warm water and we closed.
We don’t think
it was a tubal pregnancy because the tube was intact. The fact that the right
ovary was destroyed makes us believe that it was a rare case of ovarian ectopic
pregnancy which soon after the fertilization migrated into the Douglas where it
has found enough space to continue for an unusually long period of time.
The patient is
now stable and the post-op recovery is uneventful.
Dr Giuseppe
Gaido
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