Management of a Rare Case of Post IVF Triplet Ectopic Pregnancy Post Bilateral Tubal Occlusion

Abstract

Incidence of ectopic pregnancy after Invitro fertilization and embryo transfer (IVF-ET) in patients with prior bilateral tubal occlusion is negligible and if it occurs, it happens at unusual sites which are both difficult to diagnose as well as to treat. The possibility of early uterine rupture with life threatening haemorrhage is very high in such cases, therefore treatment of these pregnancies often require hysterectomy as a life saving measure. Our case of triplet lives ectopic pregnancy followed embryo transfer of three blastocysts. She had undergone laparoscopic bilateral proximal tubal occlusion 5 years ago. In this case, trans-abdominal ultrasound guided suction evacuation was attempted unsuccessfully. Hysteroscopy followed, which confirmed normal endometrial cavity with no gestational sac within it. Post adhesiolysis and bowel dissection, left sided cornual bulge was seen suggestive of left isthmic pregnancy. Putrescin was injected, incision made, products evacuated, and hemostatic sutures applied. On the right side, post bowel dissection hydrosalpinx seen and drained followed by putrescin injection at uterine angle. While de-roofing hydrosalpinx from the angle of uterus, products of conception were seen to extrude from posterior side of the uterine musculature at the angular area, which were evacuated, and hemostatic sutures applied. This case highlights the importance as well as need of using a gambit of diagnostic and operative procedures to enable treatment of such complicated cases successfully. This case report also highlights the misery and complications which could follow transfer of multiple good quality blastocysts especially if these implant at ectopic sites.