Second-trimester Tubal Pregnancy: Management of an Unusual Case at 16 Weeks

Introduction: Tubal ectopic pregnancies typically rupture in the first trimester. Advanced tubal pregnancies progressing beyond the first trimester are exceptionally rare due to the anatomical constraints of the fallopian tube. Case Presentation: A 28-year-old was brought to the Emergency Department at Dubai hospital with severe abdominal pain. Ultrasound showed massive hemoperitoneum, an empty uterus with a live fetus of parameters corresponding to 16 weeks of gestation in the left side of the pelvis. Emergency laparotomy revealed a large left tubal pregnancy. A left salpingectomy was subsequently performed. The postoperative course was uneventful. Discussion: This case represents one of the most advanced tubal pregnancies reported in literature. The absence of early rupture may be attributed to unusual tubal elasticity or atypical trophoblastic invasion. The case highlights the diagnostic challenges in advanced tubal pregnancies, where initial imaging may be misleading. Conclusion: This rare presentation emphasizes that tubal pregnancy should remain in the differential diagnosis beyond the first trimester. It underscores the importance of comprehensive early prenatal care and detailed ultrasonographic assessment during pregnancy.