Ruptured Ectopic Pregnancy with Negative Urine Pregnancy Test

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are an ST4 doctor covering Early Pregnancy Assessment Unit (EPAU). You have been asked to see 24- year- old Jaz Pringle in her third pregnancy. Her LMP was six weeks ago and has presented with left iliac fossa pain and light vaginal bleeding. Your task is: … ● To take a focussed history ● Organize the necessary investigations ● Discuss the results and diagnosis with Jaz ● Agree a management plan … You have 10 minutes for this task (+ 2mins initial reading time). This is a communication skills clinical assessment task that tests the candidate’s skills to take a focussed history, interpret and explain results and agree to a management plan having discussed the options. If they ask for the urine pregnancy test, tell them it is positive. If they arrange an ultrasound, provide them with the following result. ‘An empty uterus and a 2.3cm left sided adnexal mass with well- defined gestational sac medial to the left ovary with minimal fluid in pouch of Douglas. Right ovary appeared normal. Findings are highly suggestive of left sided tubal pregnancy’. If they organize beta HCG, tell them the nurse had sent it and the result is back and it is 2900IU/ml. Record your overall clinical impression of the candidate for each domain (e.g. should this performance be pass, borderline, or a fail). You are Ms. Jaz Pringle, a 24- year- old housewife who lives with her partner of four years. You have one child delivered by caesarean section for breech (bottom first) presentation three years ago. You had developed infection post caesarean section and were very unwell. You had needed admission to the hospital for 10 days and needed IV antibiotics. This was followed by an ectopic pregnancy 18 months ago whereby you ended up having key hole surgery and removal of your right fallopian tube with ectopic pregnancy. While you have not been actively trying for another pregnancy, you and your partner are happy with the thought of another pregnancy. However, you attended hospital due to some discomfort on the left side of the tummy and some vaginal bleeding on and off for two days. You are otherwise fit and well with no allergies. The candidate should arrange a urine pregnancy test, which will be positive. They should then organize a scan in the EPAU. The scan will suggest an ectopic pregnancy in your right tube. You are now extremely upset and anxious after the scan at the thought of possibly losing the only remaining tube and being rendered infertile. You want to know all possible options and would like to save the only fallopian tube if possible.

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A positive urine pregnancy test (UPT) with adnexal mass; ectopic pregnancy is not the ultimate diagnosis

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2018-0004 ◽

2018 ◽

Vol 0 (0) ◽

Cited By ~ 2

Author(s):

Mohd Faizal Ahmad ◽

Muhammad Azrai Abu ◽

Kah Teik Chew ◽

Kun Leng Sheng ◽

Mohd Asyraf Zakaria

Keyword(s):

Ectopic Pregnancy ◽

Adnexal Mass ◽

Case Reports ◽

First Trimester ◽

Pregnancy Test ◽

First Case ◽

Positive Urine ◽

Disease Free ◽

Urine Pregnancy Test

Abstract A positive urine pregnancy test (UPT) with adnexal mass in ectopic pregnancy is not the ultimate diagnosis. The incidence of ectopic pregnancy is about 27 per 1000 pregnancies [1]. On average, about 6–16% will present to an emergency department with first-trimester bleeding and abdominal pain [2]. On presenting with these symptoms with the simultaneous presence of an adnexal mass and an empty uterus, a UPT is of paramount importance to determine whether the symptoms are pregnancy related or not. When the UPT is positive, an ectopic pregnancy is not the only diagnosis as the rare entity of non-gestational ovarian choriocarcinoma (NGOC) should be considered. Here we present two case reports of NGOC, which were initially diagnosed as ectopic pregnancy. The first case is a 16-year-old girl, with vaginal bleeding and an adnexal mass due to an ovarian choriocarcinoma, She underwent unilateral oophorectomy and received multiple courses of chemotherapy. She is disease free without evidence of recurrence or metastasis after 12 months of follow-up. The second patient is also 16 years old and presented with an acute abdomen. She was diagnosed as a ruptured luteal cyst and underwent partial oophorectomy. When the pathologist diagnosed a choriocarcinoma she received multiple courses of chemotherapy, but thereafter an advanced disease was diagnosed with evidence of distant metastasis.

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Ruptured Ectopic Pregnancy with a Negative Urine Pregnancy Test

Baylor University Medical Center Proceedings ◽

10.1080/08998280.2017.11929547 ◽

2017 ◽

Vol 30 (1) ◽

pp. 97-98

Author(s):

Mallory Hughes ◽

Andrew Lupo ◽

Adrianne Browning

Keyword(s):

Ectopic Pregnancy ◽

Pregnancy Test ◽

Urine Pregnancy Test

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Can I Be Pregnant? – Diagnostic Challenges in Ruptured Chronic Ectopic Pregnancy

Medicine & Health ◽

10.17576/mh.2021.1602.25 ◽

2021 ◽

Vol 16 (2) ◽

pp. 301-308

Author(s):

Bhasyani Nagaretnam ◽

Keyword(s):

Abdominal Pain ◽

Ectopic Pregnancy ◽

Acute Abdomen ◽

Free Fluid ◽

Operation Theatre ◽

Pregnancy Test ◽

Obstetric Emergency ◽

Child Bearing ◽

Urine Pregnancy Test

Ectopic pregnancy is an obstetric emergency which accounts for 4% of all pregnancy-related deaths. All women of child bearing age with abdominal pain or vaginal bleeding presenting to the Emergency Department should be evaluated for ectopic pregnancy. However, there have been many reported cases of diagnostic challenges of ectopic pregnancy. One rare variant of ectopic pregnancy that can be easily overlooked is chronic ectopic pregnancy. We present this case of a 39-yearold female, who presented with acute abdomen and free fluid in her abdomen. Urine pregnancy test indicated she was not pregnant. However, intraoperative findings confirmed left tubular pregnancy. We would like to highlight three major diagnostic challenges we faced in this case i.e.; (i) women of child bearing age with abdominal pain should always be evaluated for ectopic pregnancy; (ii) diagnosis of ectopic pregnancy should not be dismissed even though the pregnancy test is negative; and (iii) the role of computed tomography (CT) scan in acute abdomen of unclear aetiology. As a rule, all haemodynamically unstable acute abdomen should be sent to the operation theatre. Haemodynamically stable patients should be carefully evaluated to facilitate surgical management.

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A life-threatening condition – ruptured ectopic pregnancy with negative urine pregnancy test: A case report

Malaysian Family Physician ◽

10.51866/cr1117 ◽

2021 ◽

Vol 16 (1) ◽

pp. 121-123

Author(s):

Fadzilah Mohamad ◽

Ahmad Shuib Yahya ◽

Aneesa Abdul Rashid ◽

Navin Kumar Devaraj ◽

Abdul Hadi Abdul Manap

Keyword(s):

Abdominal Pain ◽

Emergency Management ◽

Ectopic Pregnancy ◽

Case Reports ◽

Rare Occurrence ◽

Pregnancy Test ◽

Threatening Condition ◽

Life Threatening ◽

Rule Out ◽

Urine Pregnancy Test

Ectopic pregnancy is an extra-uterine pregnancy and is a potentially life-threatening condition that can lead to death from intra-peritoneal hemorrhage. This case reports a rare occurrence of ruptured tubal pregnancy in which the patient presented early with abdominal pain and a negative urine pregnancy test but subsequently presented again with evidence of intra-peritoneal hemorrhage. A negative urine pregnancy test is often used to rule out pregnancy, but it is not 100% sensitive. Complete assessment is critical in this important diagnosis in order to plan for the appropriate emergency management.

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A positive urine pregnancy test with haemoperitoneum: misdiagnosed postpartum choriocarcinoma with uterine rupture mimicking ruptured ectopic pregnancy

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2021-0048 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Shakti Yeoh ◽

Soon-Leong Yong ◽

Pak-Inn Teoh ◽

Marcus Kang

Keyword(s):

Ectopic Pregnancy ◽

Uterine Rupture ◽

Histopathological Examination ◽

Wedge Resection ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Emergency Laparotomy ◽

Blood Product Transfusion ◽

Pregnancy Test ◽

Urine Pregnancy Test

Abstract Objectives Choriocarcinoma after a term pregnancy is rare and can be life-threatening, especially when it perforates the uterus, resulting in massive haemoperitoneum. As uterine rupture due to choriocarcinoma is uncommonly encountered in the clinical practice, its diagnosis is often missed or delayed. Case presentation We present a case of a 41-year-old para 4 + 1 who had acute abdomen and hypovolaemic shock secondary to haemoperitoneum at three months postpartum period. The urine pregnancy test was positive, and, therefore, a provisional diagnosis of a ruptured ectopic pregnancy was made. She was managed aggressively with fluids and blood product transfusion at the emergency department to achieve haemodynamic stability. Subsequently, she underwent an emergency laparotomy where intraoperatively noted a perforation at the left posterior uterine cornu with purplish tissue spillage. A wedge resection was performed, and the histopathological examination (HPE) was reported as atypical trophoblastic cells, in which choriocarcinoma could not be ruled out. The patient then underwent a total abdominal hysterectomy three weeks later. The final HPE confirmed the diagnosis of choriocarcinoma. Conclusions The clinical presentation of postpartum choriocarcinoma can be indistinguishable from a ruptured ectopic pregnancy. A high index of suspicion is crucial to allow early diagnosis.

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