Female sterilization is one of the most commonly adopted permanent methods of contraception worldwide and is generally considered highly effective. Despite its low failure rate, pregnancy can occur following sterilization, and such pregnancies are associated with a disproportionately higher risk of ectopic implantation. Ectopic pregnancy after sterilization often presents diagnostic challenges, as prior sterilization may lead to a false sense of security and delayed clinical suspicion, thereby increasing the risk of tubal rupture and maternal morbidity. To describe the clinical presentation, diagnostic evaluation, management strategies, and maternal outcomes of ectopic pregnancies occurring after tubal sterilization. This case series includes four women with a previous history of tubal sterilization who were diagnosed with ectopic pregnancy at Vinayaka Mission's Kirupananda Variyar Medical College and Hospitals. Detailed clinical information, including age, parity, method and timing of sterilization, presenting symptoms, diagnostic findings, site of ectopic pregnancy, treatment approach, and outcomes, was collected and analyzed. Diagnosis was confirmed using urine pregnancy testing, serum beta human chorionic gonadotropin levels, and transvaginal ultrasonography. All cases were managed surgically and followed through the postoperative period. All four women presented with lower abdominal pain with or without amenorrhea. The interval between sterilization and occurrence of ectopic pregnancy ranged from 1 to 8 years. Tubal ectopic pregnancy was identified in all cases, with one patient presenting in a ruptured state requiring emergency surgical intervention. Timely diagnosis and appropriate surgical management resulted in favorable maternal outcomes in all cases, with no major postoperative complications. Ectopic pregnancy can occur even several years after tubal sterilization and should always be considered in women of reproductive age presenting with abdominal pain or menstrual irregularities, regardless of sterilization history. Maintaining a high index of clinical suspicion and ensuring early diagnostic evaluation are crucial for preventing maternal morbidity and achieving optimal outcomes.
Priyanka et al. (Thu,) studied this question.