CASE STUDY: Role of Ultrasound in the early detection of an ectopic pregnancy. Introduction.
Ectopic pregnancy is the fourth most common cause of maternal death in the United Kingdom, accounting for 80% of early pregnancy deaths (Lewis and Drife 2004).Furthermore, it is still the most common cause of maternal death in the 1st trimester of pregnancy (Condous G 2006) affecting 1:100 pregnancies (Ectopic Pregnancy Trust 2007).For this case study I will discuss the essence of scanning women who present in EPU’s with a positive pregnancy test and any symptoms of a possible ectopic pregnancy. CASE REPORT
This is the case of 32yrs old primigravida referred to an early pregnancy unit by her GP with a history of irregular menstrual cycle, heavy bleeding for a week and a positive pregnancy test which she did 10days earlier. Conception was spontaneous. Her Gestational age by her LMP was 4weeks and 4days. A transvaginal ultra-sound was performed which identified the absence of an intrauterine gestation sac. The endometrial thickness was 2.0mm, midline echo intact and thin and homogenous. The right ovary was visible and normal; the left ovary was visible and normal with a corpus luteum. An adnexal mass separate from the ovary was found adjacent to the left ovary (appendix 1). There was free fluid in the pouch of Douglas with was ground glass appearance which was consistent with haemoperitoneum and was tender to the left were the mass was situated (appendix 2). In view of the findings a left tubal ectopic was diagnosed. In keeping with the department protocol an urgent BHCG and progesterone was done whiles she was referred to the emergency team for further management. Result came back as BHCG 72 iu/l and progesterone 3.00nmol/l.. She had a laparoscopic salpingectomy for a left tubal ectopic pregnancy. Histology of the product removed laparoscopically was positive of an ectopic, and a repeat BHCG was repeated after a week. The patient was started on antibiotics and...
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