Open Access

Retained term tubal ectopic pregnancy

Gynecological SurgeryEndoscopic Imaging and Allied Techniques20108:603

Received: 3 April 2010

Accepted: 9 June 2010

Published: 22 June 2010


Ectopic pregnancyTubal pregnancyTerm tubal ectopic pregnancy


Tubal ectopic pregnancy accounts for approximately 1% of all pregnancies. Term tubal pregnancy, however is extremely rare. Review of the literature revealed that at least over 12 cases of term tubal pregnancy have been reported. Most of them were published in the 1950s [111]. The most recent article on this subject was published in 2007 [12]. We present a case of a tubal pregnancy with a macerated fetus inside.


Patient was a 32-year-old woman, G3P2, with an abdominal mass, and amenorrhea of 2-year duration. She lived in a rural area with no medical facility. Knowing about the upcoming visit of a consulting gynecologist (IAB), she and other potential patients gathered at the entrance of a hospital in Marwa City, Cameron to be selected by local nurses for examination. Physical examination revealed a hard abdominal mass filling almost the entire abdominal cavity. Due to the limited facilities, medical imaging was not available. At laparotomy, we found a macerated fetus in a hugely distended left fallopian tube. The uterus was normal and separated from the tube. The right tube and ovaries were normal. The fetus was delivered and a left salpingectomy was performed.


Our patient underwent surgery at a small hospital with limited facilities in Cameron. The hospital has no imaging or pathology services. In any event, our operative finding was clear. The fetus was inside an extremely distended and thin-walled fallopian tube (Fig. 1). A differential diagnosis in this case would include pregnancy in a rudimentary uterine horn, abdominal pregnancy, or healed ruptured term uterine pregnancy. We performed a thorough intra-operative examination and found no evidence of any uterine anomaly whatsoever. In addition, the uterus was completely normal and the abdominal cavity was free from any adhesions.
Fig. 1

A macerated fetus in a hugely distended left fallopian tube. The uterus was normal and separated from the tube

The only information that could be incorrect is the duration of pregnancy. She gave a history of amenorrhea of 2-year duration. This was obtained through two translators; one of them was a medical student. A recall bias is a possibility. Patient could not provide any information about the feeling of fetal movement.

The finding of a macerated fetus suggests that fetal death occurred long before her presentation to the hospital. In addition, she had never experience labor pain. One of the risks of retained fetal death is the occurrence of disseminated intravascular coagulation that can occur in 12.7% in cases [13]. Despite living in a destitute place with limited medical facilities, our patient did not appear to experience any coagulation disorder.

Over three million stillbirths occur each year worldwide [14, 15] If the rate of stillbirths in the US is 6.2 of 1,000 total births [16], the rates in developing countries are much higher; for example the still birth rate in Congo is 30 of 1,000 births [17, 18] Our patient had had a macerated fetus inside the fallopian tube.


Our case report suggests that although extremely rare, term tubal pregnancy can still be encountered in a place with limited medical facilities.


Authors’ Affiliations

Deptartment of Obstetrics and Gynecology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
McGill University, Montreal, Canada


  1. Waltz JH (1950) Term tubal pregnancy. A case report. North Carolina. Med J 11:634–637Google Scholar
  2. Myelin TW, Randall LM (1951) Intratubal term pregnancy without rupture: review of the literature and presentation of diagnostic criteria. Am J Obstet Gynecol 61:130Google Scholar
  3. O'Connell CP (1952) Full-term tubal pregnancy. Am J Obstet Gynecol 63:1305–1311PubMedGoogle Scholar
  4. Frachtman KG (1953) Unruptured tubal term pregnancy. Am J Surg 85:161View ArticleGoogle Scholar
  5. Gustafson GW, Bowman HE, Stout FE (1953) Extrauterine pregnancy at term. Obstet Gynecol 2:17PubMedGoogle Scholar
  6. Vaish R (1959) Term tubal pregnancy with survival of mother and infant. Am J Obstet Gynecol 77:1309–1311PubMedGoogle Scholar
  7. Kent JF (1963) Term tubal pregnancy. Aust NZ J Obstet Gynaecol 41:139–141View ArticleGoogle Scholar
  8. Marais OA (1962) Full-term tubal pregnancy with retention of skeleton for ten months. S Afr Med J 36:327–328PubMedGoogle Scholar
  9. Schokman CM (1966) Advanced tubal pregnancy: a case of survival of mother and baby. Aust NZ J Obstet Gynaecol 6:171, 13View ArticleGoogle Scholar
  10. Maas DA, Slabber CF (2007) Diagnosis and treatment of advanced extrauterine pregnancy. S Afr Med J 1975:49Google Scholar
  11. Augensen K (1983) Unruptured tubal pregnancy at term with survival of mother and child. Obstet Gynecol 61:259–260PubMedGoogle Scholar
  12. Huang SC, Hsu TY (2007) Term tubal pregnancy with a live born and healthy baby. Pediat Dev Pathol 10:69–71View ArticleGoogle Scholar
  13. Angelov A (1989) Intravascular coagulation in relation to pregnancy and delivery. Zentralbl Gynäkol 111(17):1169–1175PubMedGoogle Scholar
  14. Say L, Donner A, Gulmezoglu AM et al (2006) The prevalence of stillbirths: a systematic review. Reprod Health 3:1PubMedView ArticleGoogle Scholar
  15. Stanton C, Lawn JE, Rahman H et al (2006) Stillbirth rates: delivering estimates in 190 countries. Lancet 367:1487PubMedView ArticleGoogle Scholar
  16. MacDorman MF, Kirmeyer S (2009) Fetal and perinatal mortality, United States, 2005. Natl Vital Stat Rep 57:1PubMedGoogle Scholar
  17. McClure EM, Nalubamba-Phiri M, Goldenberg RL (2006) Stillbirth in developing countries. Int J Gynaecol Obstet 94:82PubMedView ArticleGoogle Scholar
  18. McClure EM, Wright LL, Goldenberg RL et al (2007) The global network: a prospective study of stillbirths in developing countries. Am J Obstet Gynecol 197:247PubMedView ArticleGoogle Scholar


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