"Ectopic Pregnancy in Ultrasound" is an engrossing example of a paper on pregnancy. Patient Presentation and History A 36-year old female patient presents at the Emergency Department (ED), complaining of pain in the right lower quadrant that has been increasing in severity with the passage of time, accompanied by vaginal bleeding, nausea, and vomiting. The patient has a history of difficulty in conceiving due to endometriosis and smokes one packet of cigarettes daily. Calculations based on the last menstrual period (LMP) experienced by the patient shows that she is in nine weeks gestation. The emergency doctor orders for the human chorionic gonadotropin (hCG) level of the patient and a transvaginal ultrasound examination of the patient. Test and Imaging Findings The hCG level of the patient is 4.5ng/ml.
The transvaginal ultrasound scan reveals a mass of 3.5cms width in the right fallopian tube and a lack of gestational sac in the uterus. The uterus appears normal with a normal endometrial stripe. No fluid is present in the pelvis. Diagnosis Unruptured ectopic pregnancy is the diagnosis. Differential Diagnosis The frequency of ectopic pregnancies has risen from the end of the twentieth century.
6% to 16% of patients, in their first trimester of pregnancy, arriving at the ED with complaints of pelvis pain or bleeding is diagnosed with ectopic pregnancy. When both pelvis pain and bleeding are present, the rate of ectopic pregnancy diagnosis climbs to 39% (Jeanmonod, Tomassi & Mayer, 2010). The patient has presented at the ED with complaints of pelvis pain and bleeding per vagina, which raises the possibility of ectopic pregnancy. In the early stages of pregnancy, the levels of hCG are almost doubled every three days, thus raising the levels of hCG in normal pregnancy.
In the case of ectopic pregnancy, this does not occur, and instead, the hCG levels are lowered. hCG Levels of more than 25ng/ml are the norm in the case of normal pregnancy in the first trimester, while hCG levels of less than 5ng/ml are suggestive of ectopic pregnancy (Brunner et al, 2009). The hCG level of the patient is 4.5ng/ml, which is less than 5ng/ml, increasing the probability of the patient having an ectopic pregnancy. Ectopic pregnancy is associated with the fertilized ovum being implanted on any other tissue, like the fallopian tube, the ovary, abdomen, and cervix, but not in the lining of the uterus (Brunner et al, 2009).
The ultrasound scan results show that there is the mass in the fallopian tube and the absence of an intrauterine pregnancy, supporting a diagnosis of ectopic pregnancy. In the case of a ruptured ectopic pregnancy, the ultrasound scan will show a large amount of fluid in the pelvis. The absence of fluid in the pelvis of the patient rules out the possibility of ruptured ectopic pregnancy. The patient presenting in the ED with pain in the pelvis and bleeding per vagina during the early stages of pregnancy (nine weeks), the lower than normal level of hCG during early pregnancy at 4.5ng/ml, the results of the ultrasound scan showing a mass in the fallopian tube, and the absence of intrauterine pregnancy in combination, all point to the confirmed diagnosis of ectopic pregnancy, with the site of the ectopic pregnancy being the fallopian tube.
The absence of fluid in the pelvis rules out the possibility of ruptured ectopic pregnancy.
Thus, the confirmed diagnosis for the patient is an ectopic pregnancy.
Brunner, L. S., Smeltzer, S. C., Bare, B. G., Hinkle, J. L. & Cheever, K. H. (2009). Brunner and Suddharth’s Textbook of Medical-Surgical Nursing, Twelfth Edition. Philadelphia, PA: Lippincott, Williams & Wilkins.
Jeanmonod, R., Tomassi, M. & Mayer, D. (2010). Case Studies in Emergency Medicine. New York: Cambridge University Press.