Authors: Daniel Lee, Paul Kelly, Jackelyne Reyes
Emergency Medicine Student Interest Group, American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten
In North America, ectopic pregnancy has an occurrence rate of 2 percent of all pregnancies with a little more than half occurring in the ampulla of the fallopian tube and a quarter presenting in the isthmus of the fallopian tube. This is a four-fold increase over a span of 20 years. Despite the increase of cases, the exact diagnosis is still not exact, and relies on a combination of test and exams to provide the best conclusion, including beta-HCG and ultrasound. Ensuring a prompt diagnosis is critical as the mother’s life is often at risk with this condition.
The patient case presented shows how common symptoms, abdominal pain and syncope, can often be an indication of a potentially fatal condition if misdiagnosed. These symptoms presented suddenly, resulting in the patient’s concern. With the patient being 27 years old, prime child bearing years, testing completed included beta-HCG and CT to determine possible root causes. While initial beta-HCG came back negative, the CT showed a possible torsion prompting additional consultation from an OB/GYN. An ultrasound was performed and showed a complex cystic structure with an accumulation of blood, prompting a quantitative beta-HCG test. Mothers who present with ectopic pregnancy have a 10 percent chance of death if not treated. This example shows how an initial complaint of abdominal pain could potentially result in something more fatal. Ectopic pregnancies can be managed expectantly, medically, or surgically, but ensuring proper diagnosis and treatment early is the best way to ensure safety of the mother and potential child.