Undiagnosed asymptomatic second trimester broad ligament ectopic pregnancy: a case report and mini-review

Pregnancy in the broad ligament is a retroperitoneal abdominal pregnancy. It is a rare form in which the gestational tissue gets implanted between the layers of the broad ligament. Due to its rarity, the diagnosis is infrequently established before surgical intervention. A twenty-five year old nulliparous woman presented for routine antenatal care in the second trimester (±17 weeks). Routine ultrasound revealed an empty uterus with a large pelviabdominal mass. This picture suggested and undiagnosed extra-uterine pregnancy. A right broad ligament ectopic pregnancy was diagnosed at exploratory laparotomy, excision of pregnancy and right salpingectomy was performed. Postoperative course was uneventful and serum hCG was undetectable at the fourth week after surgery. Information about this rare form of ectopic pregnancy is observational and mainly comes from reported cases. A high index of suspicion is needed for early diagnosis and intervention. Department of Obstetrics and Gynecology, Faculty of Medicine; Assiut University, Assiut, Egypt Introduction Ectopic pregnancy (EP) is one of the major causes of maternal mortality, with a reported incidence reaching 10-15% of all maternal deaths. Abdominal EP is a rare highly morbid form of ectopic pregnancy in which implantation may occur in the omentum, vital organs or large blood vessels. Broad ligament EP is a subtype of abdominal pregnancy entailing implantation of the gestational tissue between the leaves of the broad ligament. There is a great variation in the clinical presentation of this rare form of EP; ranging from being asymptomatic to rupture in labor at term. Absence of reliable clinical features makes the diagnosis more challenging and requires a high index of suspicion from the clinicians. In most cases, the diagnosis is delayed up to advanced gestational age, and is rarely established before surgery. Once the diagnosis of broad ligament EP is suspected, surgery Proceedings in Obstetrics and Gynecology, 2017;7(1):8 Second trimester broad ligament ectopic pregnancy 2 should be performed. We report a case of spontaneous broad ligament EP in a completely asymptomatic woman who presented in the second trimester for routine antenatal care. A review of reported cases of broad ligament EP extended to the second trimester is included in the discussion.