Case Study #2 Module 4

1. Patient History/Clinical Indication: 18 year old female pregnant (4 weeks) with cramping and nausea. G: 2 P: 1 AB: 0 CRL of 5mm for the estimated gestational age of 6 weeks and 2 days and the patient was 12weeks and 5 days along 2. Labs/Tests: no previous tests and no labs 3. Findings: -Uterus is anteverted/normal size and echogenicity. 6.1 x 3.3 x 3.8 cm. - Endometrium echocomplex measures 11mm in double layer thickness and is homogeneous - Rt ovary measures 3.3 x 2.7 x 1.5 cm. contains small follicles, medium + superior to Lt ovary is a round echogenic structure w/hypoechoic rim measuring 1.9 x 1.7 x 1.9cm - echogenic component measures 1.6 x 1.3 x 1.5cm - cystic center containing a round structure w/cardiac activity - no free fluid and no hematoma 4. Diagnosis live ectopic pregnancy with cardiac activity of 126 bpm 5. Differential diagnosis - Postabortion bleeding -Retained products of abortion -Molar pregnancy - Cornual myoma or abscess - Ovarian tumor - Endometrioma - Cervical phase of uterine abortion 6. Discussion As we learned in class and seen in clinicals an ectopic pregnancy is when the fetus develops outside the uterus, typically in the fallopian tubes. About 10% of maternal deaths occur from ectopic pregnancies and has increased risk in future pregnancies, as well as increased risk of repeat ectopic. Some symptoms and findings include vaginal bleeding, empty uterus ( so no IUP), a adnexal mass, and a positive pregnancy test. Some Risk factors for ectopic pregnancy include: PID, which may be due to Chlamydia infection, tobacco smoking, and assisted reproductive technology.

Many time an ectopic pregnancy can be at a greater risk when an intrauterine gestation is not present and an adnexal mass is seen. A complex adnexal mass can sometimes represent a hematoma in the peritoneal cavity. In the above case the findings determined there was no hematoma or free fluid which is a indication for hemoperitoneum. I believe this is a very interesting case because it is so cool to see a live ectopic pregnancy. I have never seen one and to be able to see it makes you realize anything can happen. I hadn't realized how common they are now compared to 15 or so years ago and about 40% of pregnancies diagnosed are ectopic ones. It is also very dangerous for the mother. I read about a case where a pregnancy was diagnosed as an ectopic, the mother was given drugs to terminate the pregnancy but when she went in for a second dose the ultrasound findings stated the ectopic was in the uterus. I think this is scary to know that the diagnosis was wrong and the mother was give drugs to terminate it. In that case, the baby was born with malformations due to the drugs. That shows how important it is to know what you are looking or and being able to tell the difference between the structures. It is devastating for the mother to have to go through something like that, and surprising that the doctors made such an inaccurate diagnosis.