Simultaneous ectopics tubal and intera-hepatic pregnancies : managed by feticide and conservative observation

Ectopic pregnancy is defined as the implantation of a fertilized ovum outside the uterine cavity, most commonly occurring within the fallopian tubes and rarely in other intra-abdominal locations. While ectopic hepatic pregnancy—embryo implants into the liver parenchyma—is extremly rare type. It is characterized by diagnostic difficulties, significant management challenges, and high rates of morbidity and mortality. This report details the first documented case of a simultaneous ruptured ectopic tubal pregnancy and ectopic hepatic pregnancy, which was successfully managed through feticide and a strategy of conservative clinical observation. A 38-year-old woman (Para 6) presented with amenorrhea and vaginal bleeding. She was shocked (BP 90/40 mmHg) due to a ruptured right tubal ectopic pregnancy, requiring emergency laparotomy and salpingectomy. Two weeks later, she complaint of with epigastric and hypochondial pain. β-hCG was found elected and Ultrasound liver scan revealed a separate, viable intrahepatic pregnancy with same gestational age. A Multidisciplinary Team (MDT) recommended termination to prevent a fatal morbidity. Ultrasound-guided feticide was performed using an intracardiac injection of 20% potasium chloride solution, which successfully achieved fetal asystole. The patient remains stable and is under conservative, antibiotic, and methotrixate with expectant management. This case highlights the critical need to maintain a high index of suspicion for secondary or persistent abdominal gestation in patients presenting with new or unresolved pain shortly after initial ectopic pregnancy management. For deeply embedded, high-risk solid-organ ectopics, local feticide followed by conservative observation offers a safer definitive treatment pathway compared to potentially high-mortality surgical excision.