Ectopic pregnancy until proven otherwise … even with a negative serum hCG test: A case report
| Autor: | Erin A. Keyser, Kelly J. Morales, Zachary A. Kopelman |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
endocrine system
Abdominal pain medicine.medical_specialty RD1-811 Ectopic pregnancy FAST Focused assessment with sonography for trauma Article Adnexal mass Miscarriage Human chorionic gonadotropin 03 medical and health sciences 0302 clinical medicine G # of total pregnancies ED Emergency department Case report medicine Vaginal bleeding 030212 general & internal medicine Hemoperitoneum 030219 obstetrics & reproductive medicine Obstetrics business.industry Obstetrics and Gynecology Gynecology and obstetrics medicine.disease P # of full-term pregnancies # of preterm pregnancies # of miscarriages and/or abortion # of living children RG1-991 CT Computed tomography Surgery hCG Human chorionic gonadotropin ACOG American College of Obstetricians and Gynecologists medicine.symptom business Exploratory surgery |
| Zdroj: | Case Reports in Women's Health, Vol 30, Iss, Pp e00288-(2021) Case Reports in Women's Health |
| ISSN: | 2214-9112 |
| DOI: | 10.1016/j.crwh.2021.e00288 |
| Popis: | Ectopic pregnancy is commonly considered in the differential diagnosis for first-trimester vaginal bleeding and acute abdominal pain in women of reproductive age. Negative human chorionic gonadotropin (hCG) tests have been considered the gold standard to rule out this life-threatening diagnosis and appropriately rising hCG levels are thought to exclude it as well. In the unique case reported here, pathology confirmed ectopic pregnancy is identified in the setting of a negative serum hCG test. The patient was a 23-year-old woman (with one living child and one earlier miscarriage) who presented to the emergency department (ED) with sudden onset of abdominal pain, vaginal bleeding and syncope. She was tachycardic but normotensive and had both a negative serum hCG test and a negative urine hCG test. Imaging demonstrated a hemoperitoneum and right adnexal mass. She was taken for emergency exploratory surgery. The right fallopian tube had a tubal mass consistent with an ectopic pregnancy as well as 500 mL of blood. Pathology confirmed the ectopic pregnancy. A literature review revealed only two prior documented cases of pathology-confirmed ectopic pregnancy in the setting of a negative serum hCG test. The patient had experienced an abortion two months earlier without a documented intrauterine pregnancy. Her hCG levels were followed to Highlights • Ectopic pregnancy can occur in a patient with a negative serum human chorionic gonadotropin (hCG) test. • Never exclude the diagnosis of ectopic pregnancy when evaluating a woman with an acute abdomen in the emergency room. • Exploratory surgery is the treatment of choice for an unstable patient with a suspected ruptured ectopic pregnancy. |
| Databáze: | OpenAIRE |
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