Lightning crotch 5 weeks pregnant1/22/2024 ![]() ![]() The patient otherwise had no known predisposing factors for a HP.Ī delay in diagnosis is more likely to require operative intervention such as salpingectomy. The patient discussed was using a low-dose progesterone-only pill, which when contraception fails and ovulation occurs may be associated with ectopic pregnancy due to impaired fallopian tube motility. HP’s are estimated to occur in 1 in 30,000 pregnancies in spontaneous conceptions and increases to 1 in 100 pregnancies if associated with ART, tubal ligation, pelvic inflammatory disease or non-infectious causes of tubal damage such as endometriosis. Such vigilance must also apply to patients presenting with a known viable IUP, and also following a termination of pregnancy. The case highlights the importance of explicitly excluding a HP in all patients presenting with pelvic pain after miscarriage. It can be potentially life-threatening if the ectopic ruptures and causes intra-abdominal bleeding. HP has traditionally been a rare diagnosis where there is a concurrent intrauterine and ectopic pregnancy. A gynecology consult was summoned and the patient was transferred to theatre for surgery. A diagnosis was made of a HP, with a suspected ruptured tubal ectopic pregnancy and retained products of conception from an incomplete miscarriage of the previously identified non-viable intrauterine pregnancy. An endometrial cavity lesion of 16x9x16mm was thought to be retained products of conception. The left-sided corpus luteal cyst was again visualized. ![]() There was a large volume of fluid in the pelvis with low-level echoes. The Emergency Physician requested a formal departmental TV US, which revealed a new solid right adnexal mass measuring 64圆0x40mm with internal vascularity and adherent to the right ovary (Fig. Her hemoglobin dropped to 12.4 g/dL, previously 15.0 g/dL. ![]() She was hemodynamically stable and mildly tender to palpate in the left iliac fossa. She re-presented to the Emergency Department 7 days later with worsening pelvic pain, mostly right sided, and ongoing mild vaginal bleeding. After observation overnight, she was discharged for expectant management of the miscarriage as she was clinically stable and had a falling β-hCG from 1442 mIU/ml to 915 mIU/ml over 24 h. There was a physiological corpus luteal cyst in the left ovary, and the right ovary was normal. This met the widely accepted ultrasound criteria for a missed miscarriage. She underwent a formal departmental transvaginal ultrasound (TV US) verified by a Consultant Radiologist that identified an intrauterine pregnancy (IUP) with crown rump length of 8.5 mm without cardiac activity, consistent with 6 + 5 weeks gestation. She had no significant past gynecological, medical or surgical history. ![]() The pregnancy was spontaneous and unplanned she was breastfeeding 6 months after a normal vaginal delivery and using the oral contraceptive pill, levonorgestrel, 30mcg daily. She was found to be pregnant with a beta human chorionic gonadotropin (β-hCG) level of 1442 mIU/ml. A 33-year-old female, gravidity two and parity one, presented to the Emergency Department with acute-onset sharp pelvic pain, right worse than left, and mild vaginal bleeding. ![]()
0 Comments
Leave a Reply.AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |