Abdominal Ectopic Pregnancy in Douglas Pouch: A Rare and Life-Threatening Case Report

Ectopic pregnancy occurs when fertilized egg implants outside the uterine cavity and is a significant contributor to maternal mortality during the first trimester. A 28-year-old woman, gravida II para 0, was referred to Dr. Soetomo General Hospital with a suspected ectopic pregnancy at 15-16 weeks of gestation and had a previous ruptured ectopic pregnancy. She experienced severe abdominal pain, nausea, vomiting, cold sweats, and vaginal spotting. A pelvic ultrasound revealed a viable extrauterine fetus along with free fluid in the peritoneal cavity. Her haemoglobin level dropped to 4.9 g/dL, and she exhibited hemodynamic instability. An emergency laparotomy was performed, revealing a ruptured abdominal pregnancy with the placental attachment to the Douglas pouch, left ovary, and omentum, along with grade III-IV adhesions. A successful left salpingo-oophorectomy and adhesiolysis were carried out. Early detection and immediate surgical management in ectopic pregnancy may prevent fatal haemorrhage and enhance maternal survival.