A 39 y.o. woman who is G9P1 and currently 6 weeks pregnant presents to the ED with a chief complaint of vaginal bleeding that began in the morning with associated lower abdominal pain and lightheadedness. Physical exam demonstrates lower abdominal tenderness without peritonitis and a small amount of blood in the posterior vaginal fossa with a closed cervical os. You obtain a serum HCG which is 8,960 and perform a transvaginal ultrasound which demonstrates the following. What’s the diagnosis?
Answer: Ectopic Pregnancy
- When performing a pelvic US in the ED, the focused question is: “Is there an intrauterine pregnancy (IUP) or not?”
- To diagnose an IUP, one must visualize a gestational sac AND either a yolk sac or fetal pole within the uterus.
- In this patient, no gestational sac nor yolk sac are visualized within the uterus.
- The left adnexa demonstrates a tubal ring concerning for an ectopic pregnancy. OBGYN was consulted who took the patient Level 1 to the OR where the ectopic pregnancy was confirmed and removed along with a left salpingectomy.
Resources:
Heaton, Heather. “Chapter 98: Ectopic Pregnancy and Emergencies in the First 20 Weeks of Pregnancy.” Tintinalli’s Emergency Medicine A Comprehensive Study GUide, 9th ed., McGraw-Hill, 2020, pp. 615–623.
Pontius E. Ectopic Pregnancy & Heterotopic Pregnancy. In: Johnson W, Nordt S, Mattu A and Swadron S, eds. CorePendium. Burbank, CA: CorePendium, LLC. https://www.emrap.org/corependium/chapter/reci4t2X66l3qk1SX/Ectopic-Pregnancy-and-Heterotopic-Pregnancy#h.za15ev4ckcfv. Updated February 2, 2024. Accessed April 17, 2024.
