ANGULAR PREGNANCY: AN ECCENTRIC IMPLANTATION WITHIN UTERINE CAVITY
AbstractAngular ectopic is a rare form of ectopic pregnancy which is diagnosed as intrauterine pregnancy on ultrasound but may rupture in second trimester leading to maternal mortality. We present a case of a 32-year-old primigravida who presented at 18 weeks gestation to the emergency department of national hospital Lahore with complaint of dizziness, sweating and epigastric pain for one hour. She had an episode of diarrhoea and vomiting at hospital followed by rapidly increased abdominal distension and signs of hypovolemic shock. Urgent ultrasound suggested rupture of posterior uterine wall and massive hemoperitoneum. An urgent laparotomy was done. Uterus was perforated by pregnancy posteriorly. baby was inside the sac and alive. But died soon after birth. Uterus was repaired in two layers. Stepwise devascularization of uterus was done due to continuous bleeding. 6 units whole blood 6 FFP were transfused. The abnormal location of this pregnancy makes it antenatal diagnosis difficult. A high index of suspicion is needed in pregnant women presenting in shock even when intrauterine location of pregnancy is diagnosed in first trimester.
Marfori CQ, Kotzen M. Angular vs. interstitial pregnancy: A case report highlighting diagnostic nuances with stark management differences. Case Rep Womens Health 2018;19(1):e00068.
Alanbay İ, Öztürk M, Karaşahin KE, Yenen MC. Angular pregnancy. Turk J Obstet Gynecol 2016;13(4):218–20.
Brincat M, Bryant-Smith A, Holland TK. The diagnosis and management of interstitial ectopic pregnancies: a review. Gynecol Surg 2019;16(1):1–5.
Capobianco G, Dessole M, Landolfi S, Fadda GM, Dessole S. Right angular pregnancy at seven weeks' gestation: a case report treated by laparoscopic approach. Clin Exp Obstet Gynecol 2015;42(5):698–700.
Hasanzadeh M, Dadgar S, Arian Y, Yousefi Y. Angular Ectopic Pregnancy Presenting as Rupture of Lateral Wall of the Uterus: Late Presentation in Gestation Week 20. Iran J Med Sci 2017;42(3):314–7.
Yassin AS, Taha MS. Interstitial Ectopic Pregnancy, Diagnosis and Management: A Case Report and Literature Review. Ann Clin Case Rep 2017;2(1):1352.
Finlinson AR, Bollig KJ, Schust DJ. Differentiating pregnancies near the uterotubal junction (angular, cornual, and interstitial): a review and recommendations. Fertil Res Pract 2020;6(1):8.