78 Folia Medica 2012; 54(4): 78-79 Copyright © 2012 Medical University Plovdiv doi: 10.2478/v10153-012-0009-1 BILATERAL SIMULTANEOUS ISTHMIC ECTOPIC PREGNANCY AFTER CLOMIPHENE INDUCTION Blagovest K. Pehlivanov, Georgi I. Amaliev, Maria L. Malinova, Ilia G. Amaliev Department of Obstetrics and Gynecology, Medical University, Plovdiv, Bulgaria ABSTRACT A rare case of a 32-year-old patient with simultaneous bilateral isthmic tubal pregnancy. A 32-year-old woman with a 3-year history of primary infertility was admitted with light vaginal bleeding and mild abdominal pain. She was 41 days after her last menstruation and 23 day after intrauterine insemination with her husband’s sperm. Clomiphene citrate (CC) was used for the induction of ovulation. In cases of ectopic pregnancy with ovulation induced by CC, doctors must be aware of the possibility of bilaterality. Key words: bilateral tubal pregnancy, ectopic pregnancy, clomiphene citrate INTRODUCTION Bilateral tubal pregnancy is very rare. The incidence of simultaneous bilateral ectopic pregnancy is 1 in 725 to 1580 ectopic pregnancies and 1 in 200,000 pregnancies. 1 According to most authors, the inci- dence is associated with the use of different forms of assisted reproductive technology (ART). 2 We report a 32-year-old patient with simultaneous bilateral isthmic tubal pregnancy after clomiphene induction and intrauterine insemination. A MEDLINE search was carried out, based on the following Medical Subject Headings (MeSH): “ectopic pregnancy”, “bilateral”, “isthmic”. No results were obtained. CASE REPORT A 32-year-old woman with a 3-year history of pri- mary infertility was admitted to hospital with light vaginal bleeding and mild abdominal pain. She was 41 days after her last menstruation and 23 day after intrauterine insemination with her husband’s sperm. Clomiphene citrate (Clostilbegyt ® Egis Pharmaceu- ticals LTD, Budapest, Hungary) was used for the induction of ovulation in doses of 100 mg/day for 5 days (days 3 to 7 of the menstrual cycle). Gynecological examination found light uterine bleeding and painful bilateral adnexal masses. Ultrasound showed a normal empty uterus with endometrium 12 mm, adnexal bilateral hypogenic formations (59.0/61.0 mm and 62.0/67.0 mm). Ec- topic tubal pregnancy was not imaged. There was no fluid in the pouch of Douglas. The serum hu- man β-chorionic gonadotropin (β-HCG) was 18,022 mUI/mL. Because of prior midline laparotomy in infancy, again laparotomy was performed. Unruptured ectopic pregnancies in the isthmic part of both tubes (3/2 cm and 3/3 cm) were found (Fig. 1). Both ovaries were presented as enlarged polycystic masses with the presence of corpus luteum on the right one. Bilateral salpingectomy was done. D&C was also performed. The patient had an uneventful recovery. The pathology report revealed bilateral tubal pregnancies, with trophoblasts in the isthmic part of both fallopian tubes. Reaction of Arias-Stella Figure 1. Operative finding showing bilateral isthmic pregnancies. REP - right tube ectopic pregnancy; LEP - left tube ectopic pregnancy; ROv - right ovary. CASE REPORT Correspondence and reprint request to: B. Pehlivanov, Department of Obstetrics and Gynecology, Medical Uni- versity, Plovdiv, Bulgaria; E-mail: blago_pehlivanov@yahoo.com; Mob.: +359 888 219 765 15A Vassil Aprilov St., Plovdiv 4002, Bulgaria Received 18 September 2012; Accepted for publication 21 November2012 Unauthenticated Download Date | 7/25/18 11:30 AM