An unusual development of an advanced ectopic pregnancy

We report about the course of an advanced ectopic pregnancy in case of uter ine leiomyomata, which was diag nosed after surgery. A vaginal bleeding app eared in the first trimester. Vaginal ultrascan was missing in those early time of pregnancy. Finally prenatal diagnosis in a center of perinatal medi cine led to a suspicious fetal morphology and gave the indication for medic al abortion. The induction of abortion with Gemeprost remained without success. Meanwhil e abdominal pain increased and a laparoscopic exploration was carried out a nd showed a big vital ectopic pregnancy. This indicated laparotomy. This ca se showed the difficulties in diagnosis of ectopic pregnancy in the second trimester and discusses possibilities of the therapeutic procedures.