Early pregnancy care

2017 ◽  
Keyword(s):  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Fallopian Tube ◽  
Early Pregnancy ◽  
Vaginal Bleeding ◽  
Clinical Skills ◽  
Management Plan ◽  
Pregnancy Test ◽  
Assessment Task ◽  
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.

scholarly journals A Ruptured Ectopic Pregnancy Presenting with a Negative Urine Pregnancy Test

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Johnathan Michael Sheele ◽  
Rachel Bernstein ◽  
Francis L. Counselman
Keyword(s):  
Emergency Department ◽  
Ectopic Pregnancy ◽  
Chorionic Gonadotropin ◽  
Early Pregnancy ◽  
Human Chorionic Gonadotropin ◽  
Rare Case ◽  
Obstetrics And Gynecology ◽  
Pregnancy Test ◽  
Beta Human Chorionic Gonadotropin ◽  
Urine Pregnancy Test

A negative urine pregnancy test in the emergency department traditionally excludes the diagnosis of pregnancy. We report a rare case of ruptured ectopic pregnancy in a patient with a negative urine pregnancy test but with a serum beta-human chorionic gonadotropin (β-hCG) of 10 mIU/mL. The patient developed hemoperitoneum and required laparoscopy by Obstetrics and Gynecology (OB/Gyn). This case highlights the fallibility of the urine pregnancy test in diagnosing early pregnancy.

scholarly journals Recurrent ipsilateral ectopic pregnancy after partial salpingectomy: case-report

2018 ◽  
Vol 7 (7) ◽  
pp. 2930
Author(s):  
Tanjona Andriamanetsiarivo Ratsiatosika ◽  
Romuald Randriamahavonjy ◽  
Baco Abdallah Abasse ◽  
Mahefarisoa Fnat ◽  
Ibrahim Housni ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Ectopic Pregnancy ◽  
Fallopian Tube ◽  
Vaginal Bleeding ◽  
Postoperative Recovery ◽  
Common Site ◽  
Threatening Condition ◽  
Life Threatening ◽  
Bilateral Salpingectomy

Ectopic pregnancy is a life-threatening condition occurring in 1-2% of all pregnancies. The most common site of implantation for an ectopic pregnancy is the fallopian tube. Authors report a case of recurrent ipsilateral ectopic pregnancy following right partial salpingectomy of a 29-Year-Old woman that led to tubal rupture. The pregnancy was conceived spontaneously. Diagnostic of ruptured ectopic pregnancy was done after clinical and ultrasonography examination. The presence of a massive hemoperitoneum with a positive pregnancy urinary test that lead us to the diagnosis of ectopic pregnancy. She underwent a laparotomy for a suspicion of ruptured ectopic pregnancy. The ectopic pregnancy was identified in the left remnant fallopian tube. Partial salpingectomy, removal of tubal stump, and resection of the uterine cornua, was performed. The postoperative recovery was uneventful. She has stayed for five days at the Hospital. All patients, even though they have already received a definitive contraception by tubal section and ligature or unilateral or by bilateral salpingectomy for any reason, must seek an ectopic pregnancy in case of pelvic pain, vaginal bleeding and/ or amenorrhea. Authors propose to carry a total salpingectomy after a chosen surgical treatment.

scholarly journals Cesarean Scar Ectopic Pregnancy

2021 ◽  
Vol 11 (5) ◽  
pp. 358-361
Author(s):  
Sunil V. Jagtap ◽  
Nitin Kshirsagar ◽  
Ramnik Singh
Keyword(s):  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Uterine Rupture ◽  
Vaginal Bleeding ◽  
Hypovolemic Shock ◽  
Lower Uterine Segment ◽  
Caesarean Scar ◽  
Anterolateral Wall ◽  
History Of ◽  
Gestational Sac

Caesarean Scar Ectopic Pregnancy (CSEP) is one of the rarest forms of ectopic pregnancy. We present a 30 year female presented with 8 weeks of amenorrhea. Her obstetric history was G3P2D2. Her B HCG levels were >10,000 IU/L. She had history of previous 2 lower uterine segment Caesarean section. She was referred to our hospital in stage of severe hypovolemic shock related to vaginal bleeding. USG findings were suggestive of death of fetus of about 6 weeks 5 days. Gestational -sac at lower uterine segment Caesarean section scar level. Radiological diagnosis was? Scar pregnancy. On histopathology diagnosed as Caesarean scar ectopic pregnancy with area of rupture in anterolateral wall of lower uterine segment and upper cervix. The endometrium was unremarkable. We are presenting this case for its rarity, clinical radiological and histopathological findings. Key words: Scar ectopic pregnancy, Uterine rupture, Gestation, Caesarean section.

scholarly journals A Molar Pregnancy within the Fallopian Tube

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Laura Allen ◽  
Charlotte Dawson ◽  
Patricia Nascu ◽  
Tyler Rouse
Keyword(s):  
Ectopic Pregnancy ◽  
Fallopian Tube ◽  
Spontaneous Abortion ◽  
Postoperative Care ◽  
Vaginal Bleeding ◽  
Adnexal Mass ◽  
First Trimester ◽  
Molar Pregnancy ◽  
Rare Occurrence

Background. Discussion of the incidence of molar pregnancy and ectopic pregnancy. Role of salpingostomy and special considerations for postoperative care.Case. The patient is a 29-year-old G7P4 who presented with vaginal bleeding in the first trimester and was initially thought to have a spontaneous abortion. Ultrasound was performed due to ongoing symptoms and an adnexal mass was noted. She underwent uncomplicated salpingostomy and was later found to have a partial molar ectopic pregnancy.Conclusion. This case illustrates the rare occurrence of a molar ectopic pregnancy. There was no indication of molar pregnancy preoperatively and this case highlights the importance of submitting and reviewing pathological specimens.

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

2018 ◽  
Vol 0 (0) ◽  
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.

scholarly journals Ruptured Ectopic Pregnancy with a Negative Urine Pregnancy Test

2017 ◽  
Vol 30 (1) ◽  
pp. 97-98
Author(s):  
Mallory Hughes ◽  
Andrew Lupo ◽  
Adrianne Browning
Keyword(s):  
Ectopic Pregnancy ◽  
Pregnancy Test ◽  
Urine Pregnancy Test

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

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.

scholarly journals Caesarean scar ectopic pregnancy of 12 weeks: a rare and unexpected long-term complication of caesarean section

2020 ◽  
Vol 9 (11) ◽  
pp. 4773
Author(s):  
Priti Agrawal ◽  
Rishi Agrawal ◽  
Sujeet Agrawal
Keyword(s):  
Abdominal Pain ◽  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Vaginal Bleeding ◽  
Hypovolemic Shock ◽  
Hemodynamic Instability ◽  
Cervix Uteri ◽  
Abdominal Ultrasonography ◽  
Presenting Symptoms ◽  
Caesarean Scar

Caesarean scar ectopic pregnancy (CSEP) is one of the rarest of all ectopic pregnancies. CSEP is a life-threatening condition and should be timely diagnosed and managed because if left untreated, it may lead to serious complications like uterine rupture, hemorrhage, hypovolemic shock and even maternal death. A 29-year-old female with history of amenorrhea 3 months, was referred from remote rural area with severe abdominal pain and vaginal bleeding for 15 days. Her previous childbirth was by caesarean section (CS), 4 years back. Trans abdominal ultrasonography (USG) revealed gestational sac in lower uterine segment and attached to anterior wall. Upper uterine segment was empty, crown lump length was 5.86 cm corresponding to 12 weeks and 3 days. As the pregnancy was 12 weeks with very thin myometrium covering it and placenta fully covering internal orifice of the cervix uteri (internal OS), took decision for laparotomy. Vaginal bleeding and abdominal pain are the most common presenting symptoms of CSEP. Severe acute abdominal pain or heavy vaginal bleeding may indicate impending rupture while hemodynamic instability may indicate rupture of CSEP. Laparoscopy or laparotomy can be done in such cases to remove pregnancy. Chose laparotomy as it would give quick, better access and control of hemorrhage in this case. The risk of CSEP and placenta accrete should be specially emphasized when counselling women requesting CS for nonmedical reasons. Prompt and accurate diagnosis using transvaginal ultrasonography (TVUS) followed by individualized treatment will significantly help to reduce morbidity related to CSEP.

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

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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