A 29 y.o. woman presents with a positive pregnancy test and lower abd pain.

She has been seen 3 times previously, nov 13, 20 and 21 with normal ultrasounds. her quant is 1,146 and her US is shown. What is wrong?

ectopic pregnancy is shown in the R adnexa

Our patient had an ectopic pregnancy in the R tube which ruptured. When she returned after she was seen 11/20,  she was told she had a miscarriage and states she “was offered a funeral for her baby”.  She did not return again until 11/29 when her ruptured ectopic was discovered.  This illustrates the difficulty in diagnosis of early pregnancy of unknown location.  Any pregnancy of unknown location should be considered as ectopic.

beware the tubal ring sign, the pregnancy is still ectopic, you must find the uterus.

In the developed world, between 1 and 2% of all reported pregnancies are ectopic. Between 1972 and 1992 there was a six-fold rise in the incidence of ectopic pregnancy.  This was attributed to three factors: increased use of assisted reproductive technology, increase in PID and increased awareness of the condition. Chlamydia has been linked to 30-50% of ectopic pregnancies.

ectopic pregnancy can be anywhere; this one is between the liver and stomach

Ectopic pregnancies can implant in many locations. They can implant in the intramyometrial portion of the Fallopian tube(cornual) which has twice the mortality of other tubal pregnancies.  It can implant in a c-section scar, the liver or spleen.

BE AWARE

4.9% of patients with ectopic have had a tubal ligation

3% have neg urine HCG and 2.6% have negative serum HCG

1.6% are missed on US

Our patient had an emergency surgery to remove the R fallopian tube and ectopic pregnancy.  She recovered uneventfully.

Sivalingam  V, Duncan W, Kirk E, et al. Diagnosis and management of ectopic pregnancy. 2011. J Fam Plnn Reprod Health Care Jul 4 doi:10.1136/jfprhc-2011-0073.

Akande V, Turner C, Horner P, et al. British fertility Society Impact of Chlamydia trachomatis in the reproductive setting: British Fertility Society Guidelines for practice. Hum Fertil(Camb) 2010;13:115-125.

Wang C, Cheng L, Zhang Z, Yuan Z. Imaging diagnosis of hepatic ectopic pregnancy: A report of one case. Intractable Rare Dis Res. 2012 Feb;1(1):40-44.

Wong E, Suat SO. Ectopic pregnancy—a diagnostic challenge in the emergency department. Eur J Emerg Med 2000 Sep;7(3):189-94.