Ectopic Pregnancy with

Hemorrhage
Brianna Carden
DMS 496
Clinical Practicum III
Summer 2015

Case History

34 year old, African American

Female, ER
Transvaginal exam
Spotting
No previous imaging
Labs
HCG- 28,842
Hematocrit- low

Case History

Medical History G7 P6 A0
Patient claimed regular prenatal care
No previous surgeries
Smoker for several years

Symptoms Spotting; no pain, no contractions, nor

decreased movement

Sonographic Findings

Figure 1
Heterogeneous, complex

fluid within intrauterine

cavity
No echogenic focal
thickening
Single hyperechoic
decidual layer

Figure 2
Avascular

Sonographic Findings

Figure 3
4.81 X 2.33 X 1.29 cm

Sonographic Findings

Figure 4
Right Adnexa
Irregular shaped sac
Small echogenic focal

thickening1
Bright echogenic ring

Figure 5
Ring of fire appearance

or peritrophoblastic
flow2

Sonographic Findings

Figure 6
No fetal cardiac activity

seen with M-mode

Figure 7
CRL
.88 cm
6w6d

Sonographic Findings

Figures 8 and 9
7.57 X 5.53 X 4.68

cm
Thickened
hyperechoic ring
around anechoic sac

Sonographic Findings

Figure 10
Heterogeneous,

complex fluid
Distinct echogenic
borders
Cul-de-sac

Sonographic Findings

Diagnosis

Actual Diagnosis
Right adnexal ectopic pregnancy with associated

hemorrhage

Definition
A high risk condition in which a fertilized ovum

implants outside the uterine cavity3

Prevalence varies but all females of

reproductive age are at risk4
Risk Factors
C-section, tubal abnormalities, PID, IUD,

increased age or parity, smoking

Diagnosis

Associations
Infertility

Common Clinical Symptoms

Bleeding, adnexal mass, pelvic pain, positive

HCG, adnexal tenderness4

Common Sonographic Findings

Pseudogestational sac, free fluid, tubal ring

adnexal mass, empty uterus, gestational sac

in adnexa

Pitfall- check all areas an ectopic

might be might miss it

Key Facts

Ectopic is the leading cause of maternal

death in the 1st trimester3
As many as 18% of women with
diagnosed ectopic pregnancies arrive at
the ER with symptoms of 1st trimester
vaginal bleeding, abdominal pain, or
both5
Untreated ectopic pregnancies may
cause rupture of the uterine tube and
lead to a medical emergency6

Follow Up

Laparoscopy treatment
Removed ectopic and right fallopian
tube
Laparoscopic surgery
Smaller, less invasive incisions
Associated with faster recovery, shorter

hospitalization, reduced overall cost, and

less pain and bleeding5

Prognosis- good after its been

removed

Conclusion

This patient was diagnosed with a right

adnexal ectopic that ruptured causing the
hemorrhage in the cul-de-sac
Treatment- laparoscopic procedure to
remove the ectopic pregnancy and right
salpingectomy.

Remember, ALWAYS scan through

entirely
An ectopic can be found in several
locations

References

1. Curry PhD, Tempkin BA, RT, RDMS. Et

al. Sonography: Introduction to Normal
Structure and Function. 3rd ed. Elsevier
Inc; 2011: 384.

2. Bolaji I, Singh M, Goddard R.

Sonographic signs in ectopic
pregnancy: update. Ultrasound [serial
online]. November 2012;20(4):192210. Available from: CINAHL Complete,
Ipswich, MA. Accessed July 10, 2015.

References

3. Barash J, Buchanan E, Hillson C.

Diagnosis and management of ectopic
pregnancy. American Family Physician
[serial online]. July 2014;90(1):34-40.
Available from: CINAHL Complete,
Ipswich, MA. Accessed July 9, 2015.
4.Rumack MD FACR, Wilson MD, J.
Charboneau MD, Levine. Et al.
Diagnostic Ultrasound. Vol. 1. 4th ed.
C.V. Mosby; 2011: 448-456.

References
5.Murtaza U, Ortmann M, Mando-Vandrick J, Lee A.

Management of first-trimester complications in

the emergency department. American Journal
Of Health-System Pharmacy [serial online].
2013 Jan 15 15, 2013;70(2):99-111. Available
from: CINAHL Complete, Ipswich, MA. Accessed
July 9, 2015.
6. Peart O. Diagnosing an Ectopic Pregnancy With
Ultrasound Imaging. Radiologic Technology
[serial online]. November 2012;84(2):181-182.
Available from: CINAHL Complete, Ipswich, MA.
Accessed July 10, 2015.