Medical Research Updates ⌠MRU⌡. Case Report

MRU 2024; Vol.1(Issue2): 1-4 ISSN 200XX |

https://www.mruj.online

Ectopic Twin Pregnancy: A case report

Nawal Ali Ahmed Mohamed

, Haitham Abdalla Ali Ismail1, Ahmed Elnour Adam Zakaria1, Abuelez Hassan

Ibrahem Abdalla2

1Department of Obstetrics and Gynecology, Faculty of Medicine & Health Sciences, University of Kordofan.

2Department of Community Medicine, Faculty of Medicine & Health Sciences, University of Kordofan

ABSTRACT

Spontaneous pregnancy of a live twin ectopic pregnancy is very rare. The obstetrics and gynecology department

at El Obeid Teaching Hospital in Sudan discovered this twin ectopic pregnancy. A prime-aged woman, p1+1, had

five days of lower abdominal pain. She also reported a seven-week menstrual stop and a positive serum HCG test.

Ultrasounds showed an ectopic twin pregnancy in the right adnexa and an embryonic-free uterine cavity. She

performed an emergency laparotomy after seeing a considerable increase in discomfort and sensitivity while

prepping the patient for surgery. The patient with hemoperitoneum and right ruptured twin pregnancy is

improving throughout follow-up. There is no definitive recommendation for treating ectopic twin pregnancies.

Keywords: Ectopic pregnancy, conception, obstetric emergency

……………………………………………………………………………………………………………………………………………………

Correspondence to: Nawal Ali Ahmed Mohamed, Faculty of Medicine & Health Sciences, University of

Kordofan, Sudan Email: nawalaliahmed79@gmail.com, Mobile: +249912661510

Cite this article: Mohamed NAA, Ismaail HAA, Zakaria AAA, Ibrahim AAH. Ectopic Twin Pregnancy: A case report.

Medical Research Updates 2024;1(2): 1-5. https://www.mruj.online/current-issue

INTRODUCTION

Ectopic pregnancies are the leading cause of

maternal mortality in the first trimester, with an

incidence of 5%–10% of all pregnancy-related

deaths. Diagnosis of ectopic pregnancies is difficult

due to clinical mimics and non-specific symptoms

of abdominal pain and vaginal bleeding [1]. Ectopic

pregnancy occurs when a fertilized ovum implants

outside of the uterine cavity. Risk factors include a

history of pelvic inflammatory disease, cigarette

smoking, fallopian tube surgery, previous ectopic

pregnancy, and infertility. Serial beta human

chorionic gonadotropin levels, serial

ultrasonography, and, at times, uterine aspiration

can be used to arrive at a definitive diagnosis.

Treatment of a diagnosed ectopic pregnancy

includes medical management with intramuscular

methotrexate, surgical management via

salpingostomy or salpingectomy, and, in rare cases,

expectant management. A woman who has been

diagnosed with an ectopic pregnancy should have

surgery right away if she has peritoneal signs or

hemodynamic instability, if her initial beta human

chorionic gonadotropin level is high, if

ultrasonography shows fetal cardiac activity

outside of the uterus, or if medical management is

not an option [2, 3]. Given the rarity of twin ectopic

pregnancies, it is important to address the question

of where they originate and whether they are

similar or not. In this report, we dealt with a case of

Medical Research Updates ⌠MRU⌡. Case Report

MRU 2024; Vol.1(Issue2): 1-4 ISSN 200XX |

https://www.mruj.online

twin ectopic pregnancy, which was detected by

chance before the development of complications.

CASE REPORT

A 37-year-old woman from Alfola city, West

Kordofan state, approximately 289 kilometers

from El-Obeid city, presented to our clinic with a

five-day history of left-sided abdominal pain and a

7-week history of amenorrhea. She was born via

cesarean section prior to the age of 20, is G3 P 1+1,

and has a prior history of miscarriage during the

third trimester of a twin pregnancy. She presented

herself at our obstetrics and gynecology facility

subsequent to receiving a diagnosis of an ectopic

pregnancy from a sonographer in her place of

residence. There was no pain, vaginal bleeding, or

gastrointestinal distress that she reported. Her

vital signs were within normal range, and the

examination revealed a soft abdomen and a small

tender lesion in the right iliac fossa. All other tests

came back normal, except for the serum HCG level,

which was positive. Images 1 and 2 show a healthy

ectopic twin pregnancy in the right adnexa,

whereas image 3 shows an empty uterine cavity.

Following the patient's counseling, an appointment

for surgery was set up. During the patient's

preoperative preparations, she complained of

severe abdominal pain and sweating. Upon

examination, the doctor found hemoperitoneum

and a ruptured right ectopic pregnancy; the patient

underwent a right salpingectomy (see Image 4).

The patient's left tube was attached to the posterior

uterine wall and had an abnormal fimbrial end,

suggesting pelvic inflammatory disease. The

patient's postoperative recovery was smooth, and

she was counseled regarding her fertility.

DISCUSSION

Ectopic twin pregnancy is a rare and hazardous

first-trimester pregnancy condition. To avoid

maternal morbidity and mortality, a high index of

suspicion and rapid intervention are required.

Unilateral tubal twins are a rare diagnosis,

occurring in approximately one in every 200,000–

2,500,000 spontaneous births [4,5].

Obstetric abdominal pain poses a challenging

diagnostic challenge in the emergency department

(ED) due to the extensive list of differential

diagnoses that must be considered and the

potential for atypical signs and symptoms

associated with each disease, which may be

exacerbated by the patient's pregnancy. However,

emergency physicians (EPs) encounter constraints

on investigative imaging modalities as a result of

the mandate to minimize embryonic radiation

exposure. In a timely manner, EPs must address

this diagnostic challenge while balancing maternal

and fetal outcomes, as any delays in decision-

making at the ED could endanger the life and well-

being of both the mother and the fetus. Ectopic

pregnancy and acute appendicitis are two common

causes of abdominal distress in pregnant women

who present to the emergency department. By the

tenth week of gestation, identification of the latter

is almost certain [6].

The fallopian tube is the most prevalent location for

ectopic pregnancy. The management of such

instances is not well defined. The surgical

technique consisting of a salpingectomy or

salpingostomy is the most common in the case of a

desire to sustain an intrauterine pregnancy. Such a

treatment is beneficial, but it has the potential

dangers associated with surgery; therefore, in

Medical Research Updates ⌠MRU⌡. Case Report

MRU 2024; Vol.1(Issue2): 1-4 ISSN 200XX |

https://www.mruj.online

certain circumstances, expectant management

appears fair [7].

The risk of rupture is higher in twin ectopic

pregnancies, and rupture is anticipated to occur in

30–50% of cases, despite the fact that the

morbidity and mortality associated with singleton

ectopic pregnancies have greatly decreased. For

these pregnancies, surgical intervention remains

the cornerstone of care [8].

In conclusion, for ectopic pregnancies, healthcare

personnel should have a high level of clinical

suspicion. While unilateral tubal twin ectopic

pregnancies are uncommon, transvaginal

ultrasonography can detect them. Laparoscopic

salpingostomy is a safe and effective procedure for

unilateral tubal twin pregnancy with a quick

recovery time.

ACKNOWLEDGMENTS

We would like to thank Professor Ahmed Ajab

eldour for his valuable assistance and guidance, as

well as the theater personnel at obstetric

department in El-Obeid Teaching Hospital for their

care and support.

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Image 1: Image of gestational sac contains two fetal

poles in the Rt Fallopian tube.

Image2: Two fetal poles and yolk sac within the RT

fallopian tube besides the empty uterine cavity.

Medical Research Updates ⌠MRU⌡. Case Report

MRU 2024; Vol.1(Issue2): 1-4 ISSN 200XX |

https://www.mruj.online

Image 3: empty uterin cavity with thick

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Image 4: Two embryonic fetuses and their

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