{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:47:50Z","timestamp":1785764870991,"version":"3.56.0"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction and importance:<\/jats:title>\n                    <jats:p>A ruptured tubal ectopic pregnancy in the second trimester is a rare presentation. In a reproductive age group presenting with a history of amenorrhea, per vaginal bleeding, abdominal pain with an empty uterus should always be suspected for ectopic pregnancy. Herein, we report a case of a ruptured tubal ectopic pregnancy in the second trimester, which was diagnosed during laparotomy for a suspected ruptured bicornuate uterus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>A 29-year-old, married, with past history of left salpingectomy, second presentation to a district hospital in Bhutan was referred twice for suspected ectopic pregnancy, misdiagnosed as pregnancy in a bicornuate uterus on ultrasonography initially.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical discussion:<\/jats:title>\n                    <jats:p>During the second referral, an emergency laparotomy found a ruptured right tubal ampullary ectopic pregnancy at 13\u00a0weeks 4\u00a0days period of gestation, massive hemoperitoneum and bowel adhesion in the left adnexal region. She had an uneventful postoperative recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Presentation of ectopic pregnancy in the late first trimester is rare and leads to increased maternal morbidity and mortality. While there are evidences of a bicornuate uterus with an intrauterine pregnancy being mistaken for an ectopic pregnancy, the reverse can also be true, as in our case.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/rc9.0000000000000058","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T13:19:54Z","timestamp":1768396794000},"page":"272-276","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Missed diagnosis in first trimester with ruptured tubal ectopic pregnancy in second trimester: a case report"],"prefix":"10.1097","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8926-4963","authenticated-orcid":false,"given":"Sonam","family":"Dechen","sequence":"first","affiliation":[{"name":"Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan"},{"name":"Department of Obstetrics and Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0763-1576","authenticated-orcid":false,"given":"Nidup","family":"Gyeltshen","sequence":"additional","affiliation":[{"name":"Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan"},{"name":"Department of Obstetrics and Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"R1-20260803","doi-asserted-by":"crossref","first-page":"e65","DOI":"10.1097\/AOG.0000000000002464","article-title":"ACOG Practice Bulletin No. 191: Tubal ectopic pregnancy","volume":"131","year":"2018","journal-title":"Obstet Gynecol"},{"key":"R2-20260803","doi-asserted-by":"crossref","first-page":"6\u201311","DOI":"10.47811\/bhj.103","article-title":"Incidence 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