A Research Case Report: Spontaneous Distal Tubal Pregnancy Post Bilateral Tubal Sterilization

Abstract

Background: Tubal sterilization as a contraception method has a high success rate; however, it also carries a low risk of incidental pregnancy. The possibility of ectopic pregnancy occurring is increased when pregnancy occurs after sterilization. We report a rare case of spontaneous right distal tubal pregnancy after bilateral laparoscopic tubal sterilization.

Presentation: A 34-year-old patient known case of sickle cell trait and hypothyroidism P2L2A1 both previous LSCS who had undergone bilateral laparoscopic tubal sterilization along with MTP presented with bleeding per vaginum, giddiness since one day and a positive urine test for pregnancy. Suspicion of ectopic pregnancy based on absence of gestational sac in the uterine cavity on ultrasound and elevated beta-human chorionic gonadotropin (β -hCG) level was made.

Intervention: Since the patient had unstable vitals, emergency laparoscopic surgery was performed, which revealed a right distal fallopian tube stump pregnancy. We performed a complete bilateral residual tubal stump excision. The patient recovered well after surgery and was discharged after three days.

Conclusion: To ensure complete sterilization, by proper technique. Clinicians should always consider the diagnosis of ectopic pregnancy in any woman of reproductive age presenting with lower abdominal pain and amenorrhea even if she has had tubal sterilization. Cafeteria approach should be implemented for contraceptive methods where couple should be acquainted with failure rates of each.

Keywords: Ectopic pregnancy; Fallopian tube pregnancy; Laparoscopic tubal sterilization