Doctors in Uttar Pradesh, India, were flabbergasted recently when an MRI scan of a 30-year-old woman revealed that she was 12 weeks’ pregnant – but in her liver, instead of her uterus – in what is probably the country’s first known case of a rare intrahepatic ectopic pregnancy.
“When I saw the scan, I could not believe my eyes,” said Dr KK Gupta, a radiologist at a private imaging centre in Meerut, who made the discovery while doing an MRI scan on the woman’s abdomen.
“The foetus was embedded in the right lobe of the liver and there were clear cardiac pulsations. I have never seen such a case in my career,” he told News18.
Diagnosis and find
The patient, after weeks of abdominal pain and vomiting, had been referred for an MRI of the abdomen – a test often used when ultrasound or routine scans fail to explain symptoms.
Gupta said the scan revealed a startling anomaly. “We observed a well-formed gestational sac inside the right lobe of the liver. The foetus measured approximately 12 weeks in gestational age. Most strikingly, the scan confirmed active cardiac pulsations, establishing that the foetus was alive. At the same time, the uterus was completely empty, ruling out a normal intrauterine pregnancy,” he said.
The foetus appeared “embedded deep into the parenchymal tissue of the liver, with blood vessels from the organ supplying nutrition to the sac”.
This confirmed that the pregnancy had implanted directly into the hepatic tissue, an occurrence almost unheard of in India.
Gupta said that the diagnosis was double-checked by repeating certain MRI sequences to rule out imaging errors.
“Initially, I thought it might be an imaging artefact. But repeated scans, taken from different planes, confirmed the presence of a live foetus within the liver tissue itself. That’s when we realised we were dealing with an extremely rare, high-risk pregnancy,” he added.
The liver does not have the structural environment necessary to support a pregnancy. As a result, the embryo cannot develop normally, and the condition becomes life-threatening if not treated early.
Only eight cases
Pregnancies outside the uterus, or ectopic pregnancies, are uncommon, accounting for 15 to 2% of all pregnancies. Most – about 97% – occur in the fallopian tubes. Rare cases are found in the ovaries or the abdominal cavity.
But intrahepatic implantation, when the fertilised egg attaches to the liver, is one of the rarest forms known in medical science.
According to published literature, only eight cases of intrahepatic ectopic pregnancy have been reported worldwide so far, in countries including China, Nigeria, the United States, and parts of Europe.
The liver is one of the most vascular organs in the body, with an extensive blood supply.
While this allows the foetus to receive nourishment temporarily, it also poses an enormous risk to the mother. The growing foetus can cause liver rupture or massive haemorrhage if not treated promptly, although in this particular case, the woman at this stage has survived.
Rare and risky
Dr Jyotsna Mehta, a renowned gynaecologist and obstetrician from Lucknow, described it as a once-in-a-lifetime case for most doctors.
“The liver’s rich blood supply can sustain foetal growth initially, but it puts the mother in grave danger. Removing the foetus is extremely risky. Even a minor surgical slip can lead to uncontrolled haemorrhage. The immediate priority is the mother’s survival. The pregnancy, unfortunately, cannot continue safely.”
She added that in similar cases worldwide, doctors had sometimes attempted to remove the foetus surgically while leaving the placenta attached, later shrinking it with medication to reduce blood loss.
“Each decision has to be highly individualised, and such surgeries demand extraordinary co-ordination between radiologists, gynaecologists and liver surgeons,” she said.
The woman is under strict medical supervision while doctors chart the safest course of treatment. A multidisciplinary team, including obstetricians, hepatobiliary surgeons, radiologists and anaesthesiologists, has been assembled to plan a complex surgery.
What causes pregnancy in liver?
Hepatic ectopic pregnancy results from an abnormal path taken by the fertilised egg. Instead of reaching the uterus, the embryo moves into the abdominal cavity and attaches to the liver.
Several factors that may possibly lead to this condition include:
- Blocked or damaged fallopian tubes;
- History of pelvic infections or surgeries that alter normal reproductive pathways; and
- Use of assisted reproductive techniques like IVF.
Medical experts say the exact reasons remain unclear, due to the condition’s rarity.
See more from MedicalBrief archives:
Under-diagnosis of ectopic pregnancies is killing women – UK expert
Woman (81) dies after removal of ‘stone baby’ foetus