Life-Threatening Ectopic Pregnancy Implanted on the Uterosacral Ligament in a LNG-IUS User: A Maternal Near-Miss Event.

BACKGROUND

Ectopic pregnancy is a major cause of first-trimester maternal morbidity and mortality. Implantation on the uterosacral ligament is exceptionally rare and may lead to catastrophic intraperitoneal bleeding.

CASE PRESENTATION: A 38-year-old woman using a levonorgestrel-releasing intrauterine system (LNG-IUS) presented in hemodynamic preshock with severe anemia and positive β-hCG. Imaging revealed a large-volume hemoperitoneum without identifiable intrauterine or adnexal gestation. Emergency diagnostic laparoscopy demonstrated approximately 5 L of hemoperitoneum and active bleeding from the right uterosacral ligament. The bleeding lesion was excised, and histopathology confirmed ectopic gestation. The patient recovered uneventfully and was discharged on postoperative Day 6.

CONCLUSION

Uterosacral ligament ectopic pregnancy is an extremely rare but potentially fatal condition. This case constitutes a maternal near-miss and underscores the importance of maintaining high suspicion and rapidly proceeding with surgical exploration when hemoperitoneum is present and diagnosis is unclear.