Lessons from a case of tubal twin pregnancy

Abstract

Unilateral tubal twin pregnancy illustrates and amplifies fundamental phenomena in developmental and reproductive anatomy. Knowledge of this condition is also important to practicing obstetricians and gynaecologists because it may constitute a diagnostic challenge, management dilemma, complex ethical issues and increased risk for maternal morbidity and mortality (Benn et al., 2016). Previously considered a rare occurence, recent data suggest that the condition is not uncommon (Svirsky et al., 2010). Indeed, there are many reports (Vohra et al., 2014), including several from Sub-Saharan Africa (Makinde and Ogunniyi, 1990). The case reported by Pulei et al., in Anat J Afr 2017; 6 (1) reveals several unique features in the profile of risk factors, location, chorionicity and amnionicity, mode and time of presentation, condition of the tube, diagnosis and fetal viability. There was no evidence of the conventional risk factors (Sivalingam et al., 2011). This is consistent with several other reported cases where it occurred spontaneously (Abi Khalil et al., 2016). In the present case, however, the patient had multiple intramural and subserosal leiomyomata. Intramural myomata are known to disrupt uterine contractility which may interfere with transport of the ovum and hence predispose to ectopic pregnancy (Ajibade et al., 2012). It is probable, therefore, that this was the predisposing factor. Accordingly, it may be useful to monitor patients with uterine fibroids for potential to suffer ectopic pregnancy. Family history of twinning may have been useful, and is advocated, in view of the fact that it is one of the major predisposing factors.