Dubai, June 14, 2024- A mother with heterotopic pregnancy, an extremely uncommon condition in which a woman has both a normal intrauterine pregnancy and an ectopic pregnancy or pregnancy outside the uterus, gave birth to a healthy baby girl at Medcare Hospital Sharjah. Despite the possibility of serious consequences, the 34-year-old Tunisian mother Mrs. Dalel Khalfaoui, opted to undergo a diagnostic laparoscopic surgery over seven months into her pregnancy to save her baby.
“This case represents a significant advancement in prenatal care, demonstrating the successful treatment of a twisted fallopian tube during a late-stage pregnancy, giving hope to other prospective parents in similar situations”, says Dr. Hala Al Khalidy, Specialist in Obstetrics and Gynaecology who led the procedure at the Medcare Hospital in Sharjah.
“Acute torsion of the fallopian tube, as seen in this instance, is extremely rare. From international medical literature, we found that Dalel’s undiagnosed ectopic pregnancy is also incredibly rare, possibly the rarest globally, comprising only one to two per cent of all ectopic pregnancies which in turn are only one per cent of normal pregnancy,” she added.
“Chronic ectopic pregnancies have typically been diagnosed no later than the 24th week, with only three or four such cases recorded worldwide, none reaching 31 weeks. Additionally, patients in those cases underwent open surgery, which carries even greater risks. Performing the diagnostic laparoscopic surgery to identify the condition while keeping both the baby and the mother safe was a major challenge for us,” Dr. Hala further said.
Mrs. Dalel and her husband, Mr. Achraf Amdouni, had been trying to conceive for five years, using medications and their dedication was ultimately rewarded when they came to know that Dalel was carrying after trying for so long. However, Mrs. Dalel started experiencing mild pain throughout her pregnancy which gradually worsened. At the 31st week of the pregnancy, the abdominal pain became so severe that she had to be taken to the emergency at Medcare Hospital, Sharjah.
Dr. Hala commented on the diagnosis, saying, “The pain was very severe and was a major cause of concern for both the mother and the baby. We involved our doctors of multiple specialities to make a differential diagnosis. But nobody could give a conclusion and her pain was not responding to rest and painkillers.”
“Despite the challenges of doing an MRI scan at this late stage of pregnancy, due to the urgency of the situation and the need for a precise diagnosis, we permitted the mother to have two MRI scans. However, the reports indicated that there were only minor ovarian cysts that were not a major cause of concern.” Dr. Hala then decided to do a diagnostic laparoscopy on the patient and enlisted the help of her colleague Dr. Mona Mohamad Saad, a consultant in Gynaecology.
Because the patient was in her third trimester, the traditional way of performing a laparoscopy through the umbilical region proved challenging. As a result, Dr Hala opted to enter through a higher place in the abdominal area. “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 continued.
Despite the risks involved, the procedure was successful. Dalel’s right fallopian tube had been twisted several times and had grown bloated and gangrenous as a result of a lack of blood supply, which was contributing to her abdominal pain. The twisted fallopian tube, which included a mass, was removed laparoscopically and sent to histopathology for evaluation. The results revealed that it was an ectopic pregnancy, with the foetus no longer growing after two months of conception, according to Dr. Mona.
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Expressing their gratitude, the couple remarked, “We are grateful to the doctors and the medical team of Medcare Hospital Sharjah for their expert care and guidance throughout this challenging process. Their unwavering support and dedication helped us realise our dreams, bringing our baby into this world.”
