A case report of dangerous pelvic infundibulum ligament in the second trimester of pregnancy with massive hemorrhage

Abstract

Rationale: Abdominal pregnancy is a rare ectopic pregnancy and its diagnosis and treatment are more challenging than those of other ectopic pregnancies. Because of a variable pregnancy site, abdominal pregnancy is associated with an increased risk of fatal abdominal hemorrhage, and consequently, an increased risk of maternal death compared with intrauterine pregnancy. Diagnoses: Pelvic infundibulum ligament pregnancy complicated with massive hemorrhage. Patient concerns: 42-year-old pregnant woman who did not undergo an obstetric examination during the first trimester presented with sudden abdominal pain during the second trimester. Abdominal pregnancy was confirmed after emergency treatment, causing difficulty in the comprehensive preoperative evaluation. Interventions: In order to save the patient life, we actively carried out surgical treatment. Outcomes: The patient recovered well after the operation and was discharged on the 11th postoperative day. Blood β-human chorionic gonadotropin (β-hCG) levels and routine blood test results were normal 1 month after the surgery, and the patient had recovered. Lessons: Several challenges are encountered in the diagnosis of abdominal pregnancy with regard to insufficient economic, cultural, and medical resources. In case of ectopic pregnancies, surgery should be the first choice of treatment, and preparations of blood transfusion are essential to combat the risk of rapid hemorrhagic shock caused by placenta implantation in the infundibulum ligament of the pelvis. The operation must be performed by experienced obstetricians and gynecologists.