A rare obstetric contraindication to the use of vaginal prostaglandins for fetal demise.

A rare obstetric contraindication to the use of vaginal prostaglandins for fetal demise is presented in the form of a case report. After two failed pitocin inductions for a third-trimester fetal demise, a patient was referred to the University of Washington for definitive management. She was delivered of an advanced intraligamentous pregnancy at laparotomy. Preoperative diagnosis can avert a futile attempt at evacuation of the dead fetus, but preoperative diagnosis of intraligamentous pregnancy is rare. When the cervix is found in the extreme anterior position high in the vagina behind the symphysis and the fetal head is below it, the diagnosis of extrauterine pregnancy should always be considered.