DIAGNOSTIC DILEMMA AND THERAPEUTIC CHALLENGES IN MANAGING RARE CASES OF ECTOPIC PREGNANCIES.

: to highlight the difficulties and challenges faced in the management of rare cases of ectopic pregnancy and find the most effective management in our setup. We present case series of rare cases of ectopic pregnancies managed in SOHAR Hospital. Incidence of rare site was 3.2%.   Introduction Ectopic Pregnancy (EP) is defined as the implantation of the fertilized egg occurs outside the uterine cavity. Reported incidence is approximately 2% of all pregnancies. (1)  The fallopian tube is the most common location, accounting for more than 90% of cases. (2) However implantation in the rare sites such as in abdomen (1%), cervix (1%), ovary (1-3%) and caesarean scar (1-3%) can occur and often results in greater morbidity because of delayed diagnosis and treatment. (2) We performed 3-year retrospective audit within our department from 09/6/2021-09/06/2024 to review the management outcome of ectopic pregnancy. 408 cases of ectopic pregnancies were managed during this period. Among them 80% were in fallopian tube, remaining were PUL 17% (71/408), scar 0.98% (4/408), cornual 0.73% (3/408), heterotopic 0.49% (2/408), ovarian 0.24% (1/408), Interstitial 0.24% (1/408). Secondary abdominal ectopic was 0.49% (2/408). As the number of cases of rare presentation of ectopic are very less, most of the gynecologists have either none or limited experience of managing such cases. Therefore, it is important to share our experience of managing these atypical cases and discuss the challenges and ways to deal more effectively and efficiently to minimize maternal morbidity and mortality due to ectopic pregnancy in unusual sites.