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Retroperitoneal Ectopic Pregnancy

Pak, Janie O., MD, MPH; Durfee, John Keyes, MD; Pedro, Lucio, DM, MBBS; Osborne, Alicea, MD; Larkins-Pettigrew, Margaret, MD, MEd

doi: 10.1097/AOG.0000000000002965
Contents: Ectopic Pregnancy: Case Report

BACKGROUND: Retroperitoneal ectopic pregnancies are rare and have a tendency to implant along major vessels of the abdomen and pelvis. Clinical manifestations can vary from no symptoms to hypovolemic shock and death.

CASE: A 30-year-old woman presented in hypovolemic shock with left flank and abdominal pain after attempting to medically terminate her first-trimester pregnancy. Intraoperative findings revealed normal pelvic organs with a massive retroperitoneal hematoma containing chorionic villi confirmed on histopathology.

CONCLUSIONS: In a woman with a pregnancy of unknown location presenting with worsening flank pain, a retroperitoneal ectopic pregnancy must be considered. Prompt diagnosis and management in a low-resource setting presents additional challenges.

A retroperitoneal ectopic pregnancy must be considered in a woman with a pregnancy of unknown location and worsening flank pain.

Department of Obstetrics and Gynecology, WONDOOR Global Health Fellowship, University Hospitals Cleveland Medical Centers, Cleveland, Ohio; the Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Georgetown Public Hospital Corporation, Guyana, South America; and Case Western Reserve University School of Medicine, Cleveland, Ohio.

Corresponding author: Janie O. Pak, MD, MPH, 4650 Palm Ave, San Diego, CA 92154; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Peer review history is available at

© 2018 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.