Delayed Vaginal Cuff Ectopic Pregnancy Following Hysterectomy: A Case Report.

Abstract

<h4>Background</h4>Vaginal cuff ectopic pregnancy after hysterectomy is extremely rare and poses diagnostic challenges due to unusual anatomical implantation and low clinical suspicion. Delay in diagnosis may result in catastrophic hemorrhage.<h4>Case presentation</h4>A 30-year-old G7P5014 (gravida 7 para 5 1 miscarriage and 4 living children, one stillbirth because of uterine rupture) woman presented 10 months after total abdominal hysterectomy and right oophorectomy with nausea and dizziness. Transvaginal ultrasound revealed a live 8-week embryo. She initially declined surgery. Two days later, she returned with abdominal pain, hypotension (BP 90/70 mmHg), and tachycardia (HR 130 bpm). Repeat ultrasound showed intra-abdominal free fluid. Emergency laparotomy revealed 2.5-L hemoperitoneum and a gestational sac implanted on the vaginal cuff. The sac was excised, hemostasis secured, and the patient recovered well after transfusion.<h4>Conclusion</h4>Clinicians should maintain high suspicion for ectopic pregnancy in reproductive-aged women with preserved ovaries, even after hysterectomy. Early diagnosis and urgent surgical intervention are essential to prevent mortality.