Ectopic Pregnancy after post partum tubal sterilization

Back Ground: Tubal sterilization is the most popular contraceptive method specially in women older than 35 years old, and most effective with at least failure rate. However pregnancy after tubalsterilization with more probably is ectopic pregnancy, a condition which may be life threatening. wepresent a case of ectopic pregnancy after tubal sterilization. We reported an ectopic pregnancy after tubal ligation with unusual beta HCG titrates.Case Presentation: A 38-year-old woman with two prior vaginal deliveries and post-partum tubalSterilization 6 years ago, was attended to emergency ward with spotting and positive pregnancy test without any abdominal pain. Gestational age was 8 weeks since last menstrual period. In physical examination, tenderness without rebound in the right lower quadrant and with cervical motion tenderness exposed. Serial beta-HCG titrated 30000 and 13000 mIU/ml with 48 hours’ interval. Sonography reported a cystic lesion measured 30*35 mm in diameters adjacent to right ovary without any fluid in pelvic cavity. Due to fall in beta-HCG titer and stable condition, patient underwent to observation. After two days the patient complained by abdominal pain with beta HCG titrated 2000 mIU/ml. In physical examination, vital sign was stable and there was no rebound tenderness. Transvaginal sonography revealed a mixed echo mass measure 40*35mm in diameters, endometrial cavity without any GS and mild amount of fluid in pelvic cavity. laparoscopy was scheduled when beta-HCG rise to 4700 and then 10000 mIU/ml. In laparoscopy, a large un-ruptured ectopic pregnancy between ovary and fallopian tube was detected. It was removed and right tube which reconnected, underwent Salpingectomy.Conclusion: In young women with amenorrhea and spotting, ectopic pregnancy must be keep in mind despite history of tubal sterilization.