Simultaneous ectopics tubal and intera-hepatic pregnancies : managed by feticide and conservative observation.

BACKGROUND: Ectopic pregnancy is defined as the implantation of a fertilized ovum outside the uterine cavity, most commonly occurring within the fallopian tubes and rarely in other intra-abdominal locations. While ectopic hepatic pregnancy-embryo implants into the liver parenchyma-is extremly rare type. It is characterized by diagnostic difficulties, significant management challenges, and high rates of morbidity and mortality. This report details the first documented case of a simultaneous ruptured ectopic tubal pregnancy and ectopic hepatic pregnancy, which was successfully managed through feticide and a strategy of conservative clinical observation.

CASE PRESENTATION: A 38-year-old woman (Para 6) presented with amenorrhea and vaginal bleeding. She was shocked (BP 90/40 mmHg) due to a ruptured right tubal ectopic pregnancy, requiring emergency laparotomy and salpingectomy. Two weeks later, she complaint of with epigastric and hypochondial pain. β-hCG was found elected and Ultrasound liver scan revealed a separate, viable intrahepatic pregnancy with same gestational age. A Multidisciplinary Team (MDT) recommended termination to prevent a fatal morbidity. Ultrasound-guided feticide was performed using an intracardiac injection of 20% potasium chloride solution, which successfully achieved fetal asystole. The patient remains stable and is under conservative, antibiotic, and methotrixate with expectant management.

CONCLUSIONS: This case highlights the critical need to maintain a high index of suspicion for secondary or persistent abdominal gestation in patients presenting with new or unresolved pain shortly after initial ectopic pregnancy management. For deeply embedded, high-risk solid-organ ectopics, local feticide followed by conservative observation offers a safer definitive treatment pathway compared to potentially high-mortality surgical excision.