Left adnexal ectopic pregnancy

Diagnosis certain

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

Age: 35 years
Gender: Female
ultrasound

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.

ultrasound

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.

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