One would think that after a hysterectomy by whatever route that the chances of pregnancy are non-existent. Unfortunately this is not the case. There have been reports of women with ectopic pregnancy after hysterectomy.

Ectopic pregnancy after hysterectomy is the rarest kind of all

This all stems from the fallopian tubes being left behind at the time of hysterectomy

The first ever case of this type of ectopic pregnancy was reported in 1859 since then 55 other cases have been reported in medical literature.

They can be divided into early and late.

Some women have the pregnancy lodged in the tubes before the uterus is taken out and thus the pregnancy gets trapped in the tubes.

Those who present late have a communication between the vagina and the fallopian tubes.

It can happen after any type of hysterectomy but is more common after a vaginal hysterectomy.

With a laparoscopic subtotal hysterectomy where the cervix is left behind the sperm can gain access to the fallopian tubes via the cervix.

People who care for women with ectopic pregnancy need to be acutely aware of this possibility especially when women return with abdominal pain shortly after a hysterectomy.

For this and other reasons women who have a hysterectomy should have their fallopian tubes removed at the same time

Chronic ectopic pregnancy remains an enigma of ectopic pregnancies. It can be very difficult to diagnose. The correct diagnosis is often not made until a laparoscopy is carried out for other reasons, for example acute on chronic pelvic pain or when there is internal bleeding resulting in collapse.

One of the reasons for this is the high incidence of negative pregnancy tests associated with chronic ectopic pregnancy, coupled with the fact that some women who have these types of ectopic pregnancy never miss a period.

This is because in some women who have irregular painful periods, the bleeding and pain that results from having an ectopic is often thought to be “just an odd period”. This confuses the clinical picture.

It is thought that with a chronic tubal ectopic pregnancy the bleeding in the tube is not initially acute and the body tries to localize the inflammatory response around the tube. Sometimes this process is successful and the body reabsorbs the pregnancy and leads to complete resolution of symptoms. If this does not happen there may be a secondary bleed that can result in internal bleeding and collapse.

If patients present when the body is trying to heal itself even ultrasound scans can be confusing and are often reported as a pelvic mass that can sometimes be confused with a ruptured ovarian cyst, particularly when the pregnancy test is negative.

It is important to have a high index of suspicion in women of reproductive age who have irregular periods and present with abdominal pain and bleeding even when the pregnancy test is negative. As a chronic ectopic pregnancy can easily be missed and have catastrophic consequences