Incidental Laparoscopic Diagnosis of a Concurrent Contralateral Ectopic Pregnancy in a Donor Egg Recipient with Left Tubal Gestation

Abstract

Background: Bilateral tubal pregnancy is a rare clinical condition. Unrecorded data have impeded a true calculation of the actual rate of incidence of this entity. Case: A 39-year-old nulliparous woman conceived in the fourth cycle of in vitro fertilization treatment, and presented to Dr. Ramesh Hospital after 5 weeks of amenorrhea, with lower abdominal pain and vaginal bleeding. Clinical examination revealed tenderness in the lower abdomen. Serum beta human chorionic gonadotropin concentration was 2606 milli-international units (mIU)/ mL. Transvaginal ultrasound examination revealed an empty uterus, a complex lesion in the left adnexa, and moderate intraperitoneal fluid suggestive of a ruptured ectopic pregnancy. Laparoscopy disclosed ectopic pregnancies in both the tubes, and bilateral salpingectomy was performed. Results: The postoperative period until discharge was uneventful, and, subsequently, the patient was lost to follow-up. Conclusions: Although the incidence of bilateral tubal pregnancy is not high, sonologists and surgeons should carefully examine both adnexae, especially in patients who conceive after in vitro fertilization and embryo transfer. Early diagnosis reduces maternal morbidity and mortality. Laparoscopy is the gold standard for both diagnosis and treatment of bilateral tubal pregnancy. Medical management can be offered if an accurate diagnosis is made by ultrasound preoperatively. Bilateral salpingostomy is another option if ovulation induction and/or intrauterine insemination have to be considered in the future. ( J GYNECOL SURG 30:236)