Ruptured ectopic pregnancy
20 year old female with two days of lower abdominal pain, LNMP 2 months prior to presentation, left lower quadrant pain on palpation, a WCC of 18.1 and Hb of 102, urinary beta HCG positive, awaiting serum beta HCG.
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Transabdominal and transvaginal sonographic evaluation of the pelvis. No intrauterine gestational sac identified. The endometrium has a normal trilaminar secretary phase appearance (11 mm thickness). Extensive complex free fluid within the pelvis, and the right paracolic gutter. The right ovary is normal in appearance, with demonstrable blood flow. The left ovary could not be clearly identified, with extensive heterogenous echogenicity material within the left adnexal region, likely haematoma. No ectopic gestational sac confidently identified, although the appearance of the left adnexa is suspicious for a ruptured ectopic pregnancy.
This case stresses the importance of laboratory results in the interpretation of ultrasonographic findings of free pelvic fluid when querying an ectopic pregnancy. At the time of scanning, the serum beta HCG value was unavailable but the urinary beta HCG was known to be positive with the LNMP 2 months prior to the study.
The findings of complex free fluid and an absent intrauterine gestation sac requires interpretation in conjunction with the beta HCG level. If the beta HCG is greater than 2000 IU, the findings are indicative of a ruptured ectopic pregnancy, in this case likely within the left adnexa.
The serum beta HCG in this case was found to be 2243.
Acknowledgment: Dr Shalini Amukotuwa and Dr Janette M Vincent
- 1. Kurjak, Asim & Chervenak, Frank A & Ian Donald Inter-University School of Medical Ultrasound 2011, Donald School textbook of ultrasound in obstetrics and gynecology, 3rd ed, Jaypee Brothers Medical Publ, New Delhi