UAE: Woman remains clueless about pregnancy outside uterus for 31 weeks

What Dalel experienced is called a heterotopic pregnancy, an extremely rare condition in which a woman has both a normal intrauterine [inside the uterus] pregnancy and an ectopic [outside the uterus] pregnancy occurring simultaneously.

In this form of ectopic pregnancy, embryo implantation occurs in the narrowest portion of the fallopian tube. This accounts for one to two percent of all ectopic pregnancies, which make up just two percent of all normal pregnancies, illustrating the rarity of this diagnosis, said the doctors who treated her.

Painful journey

Dalel and her husband, Achraf Amdouni, had been trying to conceive for five years, using medications. Their journey to parenthood had its share of difficulties but their determination to have their own child remained invincible. Their long wait was over when the couple found out about Dalel’s pregnancy last year.

However, a nagging pain kept disturbing the mother-to-be. “I used to think it was normal pain that pregnant women would usually go through,” recalled Dalel.

Though she consulted doctors at another facility where she was going for antenatal care earlier, nothing wrong was detected even after multiple tests.

But Dalel started feeling intense pain at 31 weeks of gestation. “When I was into my eighth month of pregnancy, the pain became sharper which was when I had to go into the emergency at Medcare Hospital in Sharjah.”

Dr Hala Al Khalidy, specialist in Obstetrics and Gynaecology at the Medcare Hospital in Sharjah, said many tests were conducted in vain to determine the underlying reason of Dalel’s severe abdominal pain.

“Despite the difficulties of performing an MRI scan at this late stage of pregnancy, due to the urgency of the situation and the need for an accurate diagnosis, we even allowed the mother to undergo an MRI scan twice. But, the reports said there were only small ovarian cysts which are not complicated.”

Diagnostic laparoscopy

It was then Dr Hala finally decided to do a diagnostic laparoscopy on the patient and got her colleague Dr Mona Mohamad Saad, consultant, Gynaecology on board for the procedure.

Since the patient was in her third trimester, it was difficult to follow the conventional method of doing the laparoscopy through the umbilical region. Hence, it was decided to enter through a higher point of the abdominal area, Dr Hala said.

“I counselled the patient to make her understand the need for this diagnostic surgery to see why there is such a pain and how we can treat it,” she said.

Though fraught with risks, the surgery was successful. The doctors found Dalel’s right fallopian tube was twisted a few times and had become swollen and gangrenous due to lack of blood supply, contributing to her abdominal pain. The twisted fallopian tube with a mass inside was removed laparoscopically and sent for histopathology. The result showed that it was an ectopic pregnancy and the foetus had stopped growing after two months of conception, said Dr Mona.

Rare case

Though they have treated heterotopic pregnancies earlier, the doctors said they were all diagnosed in early stages.

“In cases of heterotopic pregnancy where there is an ectopic pregnancy typically in the fallopian tube, a twisted fallopian tube can exacerbate the danger posed to the health of the mother and the baby,” pointed out Dr Mona.

Acute torsion of the fallopian tube like in Dalel’s case is a rare event. The doctors said they discovered from the international medical literature that Dalel’s undiagnosed ectopic pregnancy is also a very rare case, likely the rarest globally.

“Such chronic ectopic pregnancies have been diagnosed the latest by the 24th week. There have been only three or four such cases recorded worldwide. No case had reached 31 weeks. Also, after the diagnosis, the patients in those cases underwent open surgery, which is even riskier. It was a challenge for us to conduct the laparoscopic surgery to remove the fallopian tube with a torsion and keep the baby in the uterus and the mother safe,” explained Dr Mona.

Dr Hala said opting for the risky laparoscopy was the “bravest decision” that she had ever taken in her career.

Healthy baby

Dalel was relieved of her chronic abdominal pain immediately after the surgery. The doctors allowed her to go home and she eventually completed her full term, unlike in most cases of heterotopic pregnancies.

Two months ago, she gave birth naturally to a baby girl weighing 3kg. The doctors said they were proud that they managed to keep her safe till she completed her term and delivered a healthy baby.

Dalel and Achraf named her daughter Melissa. “She is growing normally and achieving all the milestones required for her age. I would like to thank all the staff and the medical team, especially Dr Hala who took my concerns seriously and investigated it with responsibility to provide me with the right medical advice and Dr Mona who helped her with the risky procedure so efficiently,” said Dalel.

Dr Hala said patients with high-risk of heterotopic pregnancies, such as Dalel, can explore alternative options such as in vitro fertilisation (IVF) and intrauterine insemination (IUI) procedures to conceive, offering renewed hope for those on the journey to parenthood.