| Author: Eva Račanská
Description:
40 year old IV. gravida III. para arrives for the light bleeding, 6 wks amenorrhoea and positive pregnancy test. Patient delivered spontaneously 11 years ago and twice via Caesarean section (6 and 3 years ago due to a fetal hypoxia). She had a laparoscopic left salpingectomy done 4 years ago for an ectopic, left tubal pregnancy. Serum hCG level 175 IU/l. Ultrasound examination showed no abnormalities, no gestation sac in the uterine cavity, endometrium 10 mm.
Bimanual pelvic examination with no abnormalities. patient was admitted for observation for a suspicion of an ectopic pregnancy. Serum hCG level rised up to 405...740 IU/l within 4 days, Progesteron 28..38, Estradiol 0.25. Ultrasound performed 4 days after admition showed high endometrium 21 mm, no gestation sac and hypoechogenic round formation 22 mm in diameter with a central anechogenic ring just next to the right ovary (described as a ring sign). Patient first preferred expectant strategy but agreed with a diagnostic laparoscopy after strong pelvic pain appeared. Laparoscopy showed approximately 100 ml of dark blood in the pouch of Douglas and right uterine tube with an ectopic pregnancy. Left uterine tube was removed during the previous surgery. Right salpingectomy was performed because uterine tube was devastated by the ectopic pregnancy. Histology confirmed tubal pregnancy with trophoblastic tissue invasion within the tubal wall.
Categorization:
Tubal pregnancy
Attachments:
Description: Uterus and left uterine horn, no left uterine tube present (salpingectomy was performed 4 years ago), blood in the pouch of Douglas, livid and dilated right uterine tube.
Description: Right uterine tube dilated with the ectopic pregnancy.
Description: Right uterine tube dilated with tubal pregnancy.
Description: Right cornual part of the uterus after uterine tube removal.
Description: Uterus and right round ligament afte rright uterine tube removal.