# Life‐Threatening Ectopic Pregnancy Implanted on the Uterosacral Ligament in a LNG‐IUS User: A Maternal Near‐Miss Event

## TL;DR

A rare case of life-threatening ectopic pregnancy on the uterosacral ligament in a woman using LNG-IUS highlights the need for rapid surgical intervention.

## Contribution

Reports a rare maternal near-miss event of ectopic pregnancy on the uterosacral ligament in a LNG-IUS user.

## Key findings

- Ectopic pregnancy on the uterosacral ligament can cause massive hemoperitoneum and hemodynamic instability.
- Surgical exploration is critical when hemoperitoneum is present and diagnosis is unclear.
- The patient recovered after excision of the bleeding lesion confirmed as ectopic gestation.

## Abstract

Ectopic pregnancy is a major cause of first‐trimester maternal morbidity and mortality. Implantation on the uterosacral ligament is exceptionally rare and may lead to catastrophic intraperitoneal bleeding.

A 38‐year‐old woman using a levonorgestrel‐releasing intrauterine system (LNG‐IUS) presented in hemodynamic preshock with severe anemia and positive β‐hCG. Imaging revealed a large‐volume hemoperitoneum without identifiable intrauterine or adnexal gestation. Emergency diagnostic laparoscopy demonstrated approximately 5 L of hemoperitoneum and active bleeding from the right uterosacral ligament. The bleeding lesion was excised, and histopathology confirmed ectopic gestation. The patient recovered uneventfully and was discharged on postoperative Day 6.

Uterosacral ligament ectopic pregnancy is an extremely rare but potentially fatal condition. This case constitutes a maternal near‐miss and underscores the importance of maintaining high suspicion and rapidly proceeding with surgical exploration when hemoperitoneum is present and diagnosis is unclear.