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Intraligamentous pregnancy or broad ligament pregnancy is a rare form of
ectopic pregnancy. Here, we report a case of successful treatment of
intraligamentous pregnancy with laparoscopic surgery. This case is of a 30 year
old woman, gravida 4, para 1, abortus 2. Based on clinical observations, she
was diagnosed with right adnexal ectopic pregnancy, and laparoscopic surgery
was performed. During surgery, no abnormal signs were observed within the
uterus, ovaries or fallopian tubes. However, there was a 1-2 cm mass with an
abnormal colour in her right broad ligament. The contents of the mass were
excised laparoscopically. Histological studies confirmed that the tissues in
the mass were chorionic villi and that the final diagnosis was intraligamentous
pregnancy.
Keywords: Intraligamentous, Pregnancy, Laparoscopic,
Treatment
INTRODUCTION
Intraligamentous pregnancy or
pregnancy in the broad ligament is a rare form of ectopic pregnancy. It occurs
in 1 per 300 ectopic pregnancies [1]. Although laparotomy is required in most
instances, a few case reports describe laparoscopic excision of early small
gestational sac [2]. Here, intraligamentous pregnancy successfully treated with
laparoscopic surgery is presented.
CASE PRESENTATION
A 30 year old woman, with an obstetric history,
gravida 4, para 1, abortus 2 (one elective several years earlier, and one
spontaneous two months before) and had no unusual personal or family clinical
history. At 5 week, 5 day pregnant following spontaneous conception, she
presented with slight bloody discharge. A transvaginal ultrasonography revealed
an empty endometrial cavity. There was, however, a fetal sac in the right
adnexal region. Serum β-human chorionic gonadotropin (β-HCG) level was 5878
mIU/ml. Based on clinical observations right adnexal ectopic pregnancy was
diagnosed.
This case was an intraligamentous or broad
ligament pregnancy that was diagnosed as adnexal ectopic pregnancy by
ultrasonography before surgery.
A broad ligament pregnancy usually results from
trophoblastic invasion of tubal pregnancy through the tubal serosa and into
mesosalpinx, with secondary implantation between the leaves of broad ligament
[3]. It also occurs if a uterine fistula develops between endometrial cavity
and the space between the leaves of the broad ligament or following a
spontaneous separation of an old caesarean section scar, after a uterine
perforation during a therapeutic or elective abortion or after either subtotal
or total hysterectomy [3]. In this case, her elective abortion history might be
the cause for this intraligamentous pregnancy, although we did not confirm the
presence of a uterine fistula.
1. Vierhout ME, Wallenburg HC (1985) Intraligamentary
pregnancy resulting in a live infant. Am J Obstet Gynecol 152: 878-879.
2. Apantaku O, Rana P, Inglis T (2006) Brouad ligament
ectopic pregnancy following in vitro
fertilization in a patient with previous bilateral salpingectomy. J Obstet
Gynecol 26: 474.
3. Phupong V, Tekasakul P, Kankaew K (2001) Broad
ligament twin pregnancy: A case report. J Reprod Med 46: 144-146.
4. Onan MA, Turp AB, Saltik A, Akyurek N, Taskiran C, et
al. (2005) Primary omental pregnancy: Case report. Hum Reprod 20: 807-809.
5. Rudra S, Gupta S, Taneja BK, Garg M (2013) Full-term
broad ligament pregnancy. BMJ Case Rep pii: bcr2013010329.
6. Cordero DR, Adra A, Yasin S, O'Sullivan MJ (1994)
Intraligamentary pregnancy. Obstet Gynecol Surv 49: 206-209.
7. Amal AD, Aburass R, Shawkat W, Reem B, Ola E, et al.
(2011) Full term extra uterine abdominal pregnancy: A case report. J Med Case
Rep 5: 531.
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