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Question
24 yo woman presents with syncope, abdominal pain, and normal menses 4 days prior. Urine HCG(+) and quantitative beta-HCG is 1300 with the transvaginal ultrasound seen below. Diagnosis?
Answer
Ectopic Pregnancy Pearls
- Considering the history above, transvaginal ultrasound should be performed regardless of quantitative beta-HCG; even if below the discriminatory zone (<1500-1800)
- Transvaginal ultrasound suggests ectopic pregnancy (as in the case above), with an empty uterus and free pelvic fluid (Figure 1).
- The above history plus free abdominal fluid on FAST exam also suggests the diagnosis and should expedite management (Figure 2).
- Please remember that ~15% of ectopic pregnancies present with normal menses.
References
Tintinalli, Judith, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7th Edition. 2011, McGraw-Hill Companies, Inc, China