Spontaneous Heterotrophic Pregnancy with Tubal Rupture and Delivery of a Live Baby at Term: a Case Report

Heterotopic pregnancy is the coexistence of intrauterine and extrauterine gestations. It is associated with significant maternal morbidity andmortality particularly in low resource settings. Spontaneous heterotopic pregnancy is very rarely seen with documented incidence of 1 in 30,000 pregnancies. We present the first case of heterotopic pregnancymanaged in our center with the delivery a live female baby at term.The case of a 25 year nulliparous lady who presented in our center with lower abdominal pains, amenorrhoea and an ultrasound report confirming an intrauterine pregnancy is presented. Examination revealed mild right iliac fossa tenderness, cervical motion tenderness and a bulky uterus. A trans-vaginal ultrasound scan confirmed a right fimbrial ectopic gestation. A right salpingectomy was performed. The patient subsequently had an uneventful antenatal period and spontaneous vaginal delivery of a live female baby at term. We also review literatures on heterotopicpregnancy and its management. Spontaneous heterotopic pregnancy, apotentially fatal condition though rare can occur in our environment. Clinicians should maintain a high index of suspicion in all patients presenting with amenorrhoea and abdominal pains even if an intrauterine pregnancy has been confirmed and a thorough evaluation of theadnexae using a trans-vaginal ultrasound scan should be routinely performed in such cases.Keywords: Spontaneous heterotopic pregnancy, live baby, Uy

Perforation of the Rectum by a Copper-T Intrauterine Contraceptive Device with Retrieval per Rectum: A Case Report

Intrauterine contraceptive devices are among the most effective forms of contraceptives available. They provide long term reversible protection from pregnancy and are currently the most popular and widely use reversible contraceptive method. Though they are associated with few side effects, perforation of the uterus remains the most serious. We report the case of a grandmultiparous lady whose copper-IUCD perforated her rectum 8 years after its insertion. We advocate the inclusion of rectal examination in theevaluation of patients for missing IUCDs and removal of the devices per rectum if partially embedded rather than resorting to surgery.Key Words: Rectum, Perforation, IUC