Abstract
BACKGROUND: Ectopic pregnancy (EP) complicates approximately 1% to 2% of pregnancies. Most EPs implant in the fallopian tube and present in the first trimester; continuation beyond 10 weeks is extremely uncommon. CASE PRESENTATION: An 18-year-old primigravida at 12 weeks' gestation presented with acute-onset lower abdominal pain, syncope, and 1 week of dark-red spotting. She was hypotensive (BP 90/60 mmHg) and tachycardic (112 bpm) with pale conjunctivae. Abdominal examination revealed lower-quadrant tenderness; pelvic exam showed a closed cervix and a tender posterior fornix. Transabdominal ultrasound demonstrated an empty uterus, a gestational sac with a fetal pole adjacent to the right adnexa, and moderate free intraperitoneal fluid. MANAGEMENT AND OUTCOME: Emergency laparotomy was performed. Approximately 800 mL of hemoperitoneum was evacuated. The right fallopian tube was found ruptured in the ampullary segment with extrusion of a formed fetus. Right salpingectomy was performed, and hemostasis achieved. The patient received 2 units of packed red blood cells intraoperatively and recovered without complication. A follow-up ultrasound at 6 weeks showed a normal remaining adnexa. CONCLUSION: This rare case of a 12-week tubal ectopic pregnancy with an advanced fetus highlights critical diagnostic challenges. Delayed presentation and lack of early prenatal imaging allowed the tubal pregnancy to progress to late gestation. High clinical suspicion and prompt ultrasound evaluation are essential for early detection of atypical ectopic pregnancies, to prevent catastrophic hemorrhage and preserve fertility.