Presentation
Severe abdominal pains. Currently on copper-T intrauterine contraceptive device (IUCD) with positive pregnancy test.
Patient Data
A right adnexal extra uterine gestational sac measuring 2.6 x 3.4 cm in size with echogenic thick outer double decidual wall outline and mildly irregularly outlined fluid center is noted. A visible fetal nodule (non-viable; no cardiac activity and corresponding to 6 weeks 4 days gestation by crown rump length) is demonstrable within the gestational sac. There is low to mid level echo free fluid noted within the bilateral iliac fossae, the Douglas pouch and at the Morrison's recess consistent with hemorrhages. Some of the right iliac fossa fluid demonstrates solid contracting tendency (hematoma).
The uterus is anteverted and shows smooth outer contours and is non-gravid. The copper-T intrauterine contraceptive device (IUCD) is in situ. Both ovaries are normal and the left adnexum is clear.
Case Discussion
An actively leaking right adnexal gestational sac with a non viable embryo at 6 weeks 4 days maturity with an intrauterine contraceptive device (IUCD) in situ.
Serial beta HCG serum levels were not done immediately after the scan procedure as the patient was becoming hypotensive and was rushed for surgical management. Post operative findings revealed a right adnexal ectopic pregnancy, a non-viable embryo and hemoperitoneum. The contraceptive device was removed at the time of management of the ectopic gestation.
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