Presentation
8 week pregnant patient with per vaginal bleeding and a continuously rising bHCG. Prior ultrasound examination reported a sac-like intrauterine structure that was continuously changing its shape and was diagnosed as an incomplete abortion. Previous history of right salpingectomy for ectopic pregnancy.
Patient Data
No intrauterine gestational sacs seen.
The uterine cavity is clear with smooth lining. A small clot is seen in lower
part of uterine cavity.
Ovaries: Right: surgically removed. Left: Unremarkable, seen separate from the mass.
A left adnexal mass is identified measuring about 2.5 x 2cm, a gestational
sac is seen with a fetal pole (7 mm) and positive cardiac pulsations.
No pelvic free fluid is identified.
The patient was counseled about surgical intervention but she refused as she had had a previous right salpingectomy. So she received methotrexate with a decline of bHCG and was then discharged to follow up in outpatient clinic.
Patient received methotrexate and a follow up endovaginal study was done 3 weeks later; that revealed enlargement of the fetal pole with a CRL reaching 13mm, yet with no cardiac activity noted.
Case Discussion
The only definite sign of ectopic pregnancy is seeing an extrauterine gestational sac with a fetal pole, especially if visible positive cardiac pulsations.