Clinical Case of the Month: Ectopic Pregnancy
April 1, 2010
An ectopic pregnancy is a condition in which an abnormal pregnancy occurs and the fertilized egg attaches to a region outside of the womb (uterus). It is estimated that 20 of every 1,000 pregnancies are ectopic. 95% occur in the ampulla or isthmus of the fallopian tube, 2-3% are interstitial, while cervical, ovarian, and abdominal ectopics are rare. While there is no way to save the fetus during an ectopic pregnancy, quick treatment of this condition is necessary as continued growth of the egg may cause damage or rupture of the attached region.
Clinically, patients present 6-8 weeks after their last menstrual period, however it may be later. Classic symptoms include amenorrhea followed by vaginal bleeding, and localized pelvic pain. If the fallopian tube ruptures, the patient may present with sharp stabbing pain in the pelvis, vaginal bleeding, dizziness, and possible hypotension.
Ultrasound is a non-invasive imaging procedure used to visualize the condition of a pregnancy. Abdominal and transvaginal ultrasound is often used to visualize the intrauterine gestational sac – absence of this intrauterine gestational sac suggests the presence of an ectopic pregnancy.
Case Study: Abdominal ultrasound imaging of the pelvis was used to diagnose this right-side ectopic pregnancy.
Technology: Toshiba Aplio XG ultrasound.
Patient History: A 25 year old female presented to the emergency room with right lower quadrant pain, nausea, and vomiting. The patient was gravid 3 Para 1. The patient’s quantitative beta-hcg level was 1,843 IU. The patient’s clinical history was significant for prior ectopic pregnancy.
Ultrasound imaging of the pelvis shows a normal appearing uterus with a normal endometrial stripe. No intrauterine pregnancy is noted. The images of the right adnexa show a right paraovarian cystic lesion with thick echogenic rim. A small amount of free fluid is located in the posterior cul-de-sac.
The ultrasound findings, combined with the patient’s beta-hcg levels, are diagnostic of a right sided ectopic pregnancy. The ectopic gestation contains a yolk sac and possibly a fetal pole; however, no embryonic cardiac activity was identified.
Image Gallery
Normal uterus with abnormal right ovary show paraovarian cyst small pocket of fluid in the posterior cul de sac. Images courtesy of Amy Rutledge, RDMS Chief Sonographer, University Hospital Case Medical Center
Reference:
E A. Lyons, The first trimester, C M Rumack, Diagnostic Ultrasound, Third edition 2005, Obstetrics and Gynecology, Volume 1, Berman, Craig, and Kawamura.