Tubal ectopic monochorionic monoamniotic twin pregnancy

Ectopic pregnancy (EP) is the implantation of the fertilized ovum in somewhere other than the uterine cavity. The incidence of developing a unilateral tubal twin pregnancy is almost 1 in 125,000 of all pregnancies and 1:200 of ectopic pregnancies with majority being monochorionic and monoamniotic. A 20year old gravida 2, para 1 woman was admitted to our emergency service with a complaint of severe lower abdominal pain and vaginal spotting lasting for 10 days. On her physcial examination there was a mild muscle guarding but no rigidity or rebound tenderness. During bimanual examination there was pain on cervical movement and tenderness on the right adnexal site. Her transvaginal ultrasound revealed but a large heterogenous lesion in the right adnexa with one gestational sac with two fetal poles in it. These ultrasound findings were concordant with monochorionic monoamniotic twin ectopic pregnancy with crown rump length (CRL), one with 0. 74 cm (6 weeks and 4 days) and the other 0.65 cm (6 weeks and 4 days). There was no amniotic border or band between two embryos so they are accepted as monochorionic monoamniotic gestation. The patient underwent an exploratory laparatomy via Pfannenstiel incision and an intact ectopic pregnancy sac with dimensions of 4x3 cm in the ampullary region of the right tuba was seen. A right salpingectomy was performed, which confirmed a twin tubal ectopic pregnancy. The patient was discharged from the hospital on her 3rd postoperative day without any complications.

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