Nabeesathul Marriam Nushha*

Department of Obstetrics and Gynaecology, Kerala University of Health and Science, India

*Corresponding Author: Nabeesathul Marriam Nushha, Department of Obstetrics and Gynaecology, Kerala University of Health and Science, India.

Received: February 17, 2026; Published: March 26, 2026

Atypical ectopic pregnancies represent an uncommon yet clinically relevant category of ectopic gestations, characterized by heightened diagnostic challenges and an elevated risk of severe maternal morbidity. Their atypical implantation sites, diverse clinical manifestations, and absence of standardized management protocols sometimes result in delayed diagnosis and intricate treatment decisions. This case series delineates five instances of unusual ectopic pregnancies, encompassing cesarean scar pregnancy, cornual ectopic pregnancy, heterotopic pregnancy, tubal ectopic pregnancy with ambiguous first findings, and cervical ectopic pregnancy. The clinical spectrum extended from minor vaginal spotting in hemodynamically stable patients to acute abdomen accompanied by hypovolemic shock. A combination of a clinical exam, serial serum β-human chorionic gonadotropin tests, and transvaginal ultrasound were used to make the diagnosis. Management techniques were tailored according to implantation site, gestational age, hemodynamic stability, and fertility preservation objectives, encompassing systemic and local methotrexate medication, laparoscopic surgery, and emergency laparotomy. All instances had good outcomes when they were treated quickly. This case series underscores the necessity of sustaining a heightened index of suspicion for atypical ectopic pregnancies, even when an intrauterine pregnancy or abnormal symptoms are present. Early diagnosis, precise imaging, and customized therapy are crucial to mitigate morbidity and enhance maternal outcomes while conserving future reproductive health.

Keywords: Atypical Ectopic Pregnancy; Cesarean Scar Pregnancy; Cornual Ectopic Pregnancy; Cervical Ectopic Pregnancy; Heterotopic Pregnancy; Methotrexate; Laparoscopy

References

1. Vadakekut ES and Gnugnoli DM. ‘Ectopic Pregnancy”. In: StatPearls. Treasure Island (FL): StatPearls Publishing (2025).
2. Dagar M., et al. “Interstitial and Cornual Ectopic Pregnancy: Conservative Surgical and Medical Management”. Journal of Obstetrics and Gynaecology of India6 (2018): 471-476.
3. Stucki D and Buss J. “The ectopic pregnancy, a diagnostic and therapeutic challenge”. Journal of Medicine and Life 1 (2008): 40.
4. Tang P., et al. “The trend of the distribution of ectopic pregnancy sites and the clinical characteristics of caesarean scar pregnancy”. Reproductive Health1 (2022): 182.
5. Bernaschek G., et al. “Vaginal sonography versus serum human chorionic gonadotropin in early detection of pregnancy”. American Journal of Obstetrics and Gynecology3 (1988): 608-612.
6. Papageorgiou D., et al. “Tubal Ectopic Pregnancy: From Diagnosis to Treatment”. Biomedicines 6 (2025): 1465.
7. Taghavi S., et al. “Hypovolemia and Hypovolemic Shock”. In: StatPearls. Treasure Island (FL): StatPearls Publishing (2025).
8. Mullany Kellie., et al. “Overview of ectopic pregnancy diagnosis, management, and innovation”. Women's health (London, England) 19 (2023): 17455057231160349.
9. Habib Asia., et al. “Methotrexate vs. Surgery in the Management of Ectopic Pregnancy: A Comparative Analysis of Treatment Outcomes”. Cureus 6 (2025): e85169.
10. Talwar Pankaj., et al. “Systemic methotrexate: An effective alternative to surgery for management of unruptured ectopic pregnancy”. Medical journal, Armed Forces India2 (2013): 130-133.
11. Sokalska A., et al. “Nontubal ectopic pregnancies: overview of diagnosis and treatment”. Fertility and Sterility 3 (2023): 553-562.
12. Nongrum Saahil Manna L., et al. “Atypical presentations of ectopic pregnancies in a rural tertiary care hospital-A case series”. Journal of Family Medicine and Primary Care3 (2023): 590-593.
13. Lee B., et al. “A Trio of Atypical Ectopic Pregnancies”. JSLS: Journal of the Society of Laparoscopic & Robotic Surgeons3 (2025): e2025-00072.
14. Birch EM., et al. “Not like the textbook: an atypical case of ectopic pregnancy”. Cureus10 (2022).
15. Nkwelle EE., et al. “An Atypical Case of Second Trimester Ectopic Pregnancy: A Case Report”. Journal of Midwifery and Reproductive Health 4 (2025).
16. Nongrum SM., et al. “Atypical presentations of ectopic pregnancies in a rural tertiary care hospital—A case series”. Journal of Family Medicine and Primary Care3 (2023): 590-593.
17. Thanasa A., et al. “Interstitial Ectopic Pregnancy Associated With Painless and Severe Vaginal Bleeding: A Rare, Atypical Clinical Presentation”. Cureus1 (2024).
18. Katsura D., et al. “Atypical fetal junctional ectopic tachycardia: a case report and literature review”. BMC Pregnancy and Childbirth1 (2022): 311.

Citation

Citation: Nabeesathul Marriam Nushha. “Atypical Ectopic Pregnancies - A case Series Clinical Scenarios and Management Challenges". Acta Scientific Medical Sciences 10.4 (2026): 37-41.

Copyright

Copyright: © 2026 Nabeesathul Marriam Nushha. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.