A 34-year-old mother gave birth to a healthy baby at Medcare Hospital Sharjah after undergoing a rare complication in her pregnancy, which caused the formation of a foetus outside the uterus.
Heterotopic pregnancy is a rare condition in which a woman has both a normal intrauterine pregnancy and an ectopic pregnancy or pregnancy outside the uterus.
Dalel Khalfaoui, a Tunisian, had a twisted fallopian tube which was discovered at a late-stage of her pregnancy. She opted to undergo a diagnostic laparoscopic surgery seven months into her pregnancy in order to save her baby.
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Dr Hala Al Khalidy, specialist in obstetrics and gynaecology who led the procedure at the Medcare Hospital in Sharjah said that acute torsion of the fallopian tube is extremely rare. “Khalfaoui’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 pregnancies,” she added.
According to the doctor, 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 an 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,” said Dr Hala.
Khalfaoui and her husband, Achraf Amdouni, had been trying to conceive for five years using medications. Their dedication was ultimately rewarded when they got to know that Khalfaoui was carrying. However, Khalfaoui was experiencing mild pain throughout her pregnancy which worsened gradually. In the 31st week of the pregnancy, the abdominal pain became so severe that she had to be rushed to the Emergency Room at the hospital.
“The pain was very severe and a major cause of concern for both the mother and the baby. We involved our doctors, who were of multiple specialities, to make a differential diagnosis. But nobody could give a conclusion and her pain was not responding to rest and painkillers,” said Dr Hala.
“Despite the challenges of doing an MRI scan at the 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,” said Dr Hala who 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.
Khalfaoui’s right fallopian tube had been twisted several times. It was 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, said Dr Mona.
Khalfaoui said, “Learning about the twisted fallopian tube and the associated risks was incredibly frightening and disheartening for us. After struggling for so long to conceive, the thought of facing these complications and putting our baby in danger was overwhelming. It felt like another obstacle in our already difficult journey.”
According to Dr Hala, embryo implantation occurs in the narrowest portion of the fallopian tube. Thus, in cases of heterotopic pregnancy, a twisted fallopian tube can exacerbate the danger posed to the health of the mother and the baby by impairing the normal movement of the fertilised egg, increasing the likelihood of ectopic pregnancy. Additionally, it can lead to reduced blood flow, further compromising the baby’s health.
“Khalfaoui underwent a minimally invasive laparoscopic surgery during the late stages of her pregnancy, a necessary but risky procedure. The surgery was successful, and the mother delivered a healthy baby girl weighing three kilogrammes,” said Dr Hala.
“We are grateful to the doctors and the medical team for their care and guidance throughout this challenging process. Their unwavering support and dedication helped us realise our dreams, bringing our baby into this world,”