A Rare Case of Ectopic molar pregnancy

A 35-year-old woman presented with gradually worsening abdominal pain over the past 15 days. The pain was accompanied by two episodes of vomiting and vaginal bleeding since the last nine days––following three months of amenorrhea. 

The lady had had two lower-segment cesarean sections previously, and both her children were alive. A positive urine pregnancy test on the 98th day of the missed period prompted her visit. She denied any abnormal vaginal discharge, grape-like vesicles, or fainting episodes, with no significant personal or family history. She had consulted a local practitioner for vaginal bleeding recently and was diagnosed with an unruptured ectopic pregnancy on the right side and referred to a tertiary care center. 

Upon arrival at the emergency department, she was hemodynamically stable. An ultrasound revealed a right-sided mass (6.08 x 4.21cm), suggestive of an unruptured right tubal pregnancy or tubal abortion, along with a bulky uterus and moderate free fluid in the pouch of Douglas. The β-hCG level on admission was 74,768 IU/ml.

The patient underwent exploratory laparotomy, revealing an 8 x 3cm unruptured tubal pregnancy in the right fimbria and indications of a prior laparoscopic tubectomy based on fallope rings on both tubes. 

A bilateral salpingectomy was performed, considering her family planning and risk reduction of future ectopic pregnancies. The patient had an uneventful intraoperative and postoperative course, was discharged on the fourth postoperative day, and followed up with weekly quantitative β-hCG titers until three consecutive negative results.

Histopathological analysis confirmed a partial molar pregnancy, a rare entity with clinical and pathological significance. 

Chronic Ectopic Molar pregnancy, though uncommon, requires ongoing monitoring post-treatment, similar to uterine molar pregnancies. It is emphasized that a urine pregnancy test is advisable for all reproductive-age patients with amenorrhea, regardless of tubectomy status. The serum β-hCG levels should guide management decisions, especially in unruptured ectopic pregnancies, with histopathological examination serving as the gold standard for diagnosis.

Source: Radhakrishnan P, Alexander M C, Patil R N. ObstetGynecol Res. 2023;10(4):498-501