Ruptured ectopic pregnancy in a patient on levonorgestrel subdermal implant in-situ: a case report

Ectopic pregnancy is a major cause of first-trimester maternal morbidity and mortality, particularly in low-resource settings where delayed diagnosis often leads to tubal rupture. Although levonorgestrel implants are highly effective, pregnancies that occur in users carry a higher likelihood of ectopic implantation. A 28-year-old Gravida 3 Para 3 presented with severe lower abdominal pain, dizziness, abnormal vaginal bleeding, and eight weeks of amenorrhoea while remaining hemodynamically compensated. A positive pregnancy test, PCV of 26%, and ultrasound showing a right adnexal mass with free fluid confirmed ectopic pregnancy despite recent Jadelle implant reinsertion. Emergency laparotomy revealed 1.5 litres of haemoperitoneum and a ruptured right ampullary ectopic pregnancy, leading to right salpingectomy and uneventful recovery after transfusion. This case highlights how early vital signs may remain deceptively stable despite massive haemoperitoneum, underscoring the need for clinical vigilance. Routine pregnancy testing in all reproductive-age women with abdominal pain is essential, regardless of contraceptive use or recent implant replacement. Ultrasound findings and low PCV provided crucial diagnostic support, while timely surgery and resuscitation were lifesaving. Ectopic pregnancy should always be considered in reproductive-age women presenting with abdominal pain. Early diagnosis and prompt surgical intervention are critical to reducing preventable maternal morbidity and mortality.