A 34 year old female presented to the ED 4 days prior with vaginal bleeding. UPT positive at home. Radiology department pelvic US performed, no IUP seen, beta HCG was 477.
She was discharged home with instructions for repeat studies in 48 hours. She returned to the ED with abdominal cramping and persistent vaginal bleeding 4 days later. Repeat Beta HCG was 590.
She was seen by OB/GYN and opted to treat with Methotrexate and return to the ED for serial labs and follow-up. She presented again 2 days later with worsening symptoms and a larger adnexal mass. She was taken to the OR for operative management of the ectopic pregnancy.
-Beta HCG normally doubles every 48 hours.
-ALWAYS ask about fertility treatments (risk of heterotopic pregnancy)
-To confirm IUP you need at minimum see a gestational sac ≥25mm with a yolk sac surrounded by ≥8mm of uterine tissue. Fetus and FHR are also great to see (in a gestational sac)
-When looking at the adnexa, be weary around the ovaries as ectopic pregnancies can look like follicles or cysts