Delayed Diagnosis of Ectopic Pregnancy Leads to Total Salpingectomy

Case Overview

This case involves a pregnant woman, previously using Yasmin, who was being followed by an obstetrician. She had her serial B-hCG level evaluated for a suspected ectopic pregnancy. No notation was made in the medical record about counseling the patient regarding the differential diagnoses of spontaneous abortion or possible ectopic pregnancy. An ultrasound that was conducted at six weeks was reported to be normal. The next assessment at seven and a half weeks noted that the patient was complaining of pelvic and rectal pain with increasing pressure. The status of this patient at this point was now changed from a normal pregnancy to ruling out ectopic pregnancy. A vaginal ultrasound performed documented a spontaneous abortion with no evidence of pregnancy and an anteverted uterus measuring 7.0 x 4.5 x 4.9cm. The next visit by the patient was to assess an evolving situation of the complex fluid building in the peritoneal space and, at this point, a definitive diagnosis of an ectopic pregnancy was made. The plan was to proceed with surgical intervention and an immediate laparoscopic abdominal surgery was performed. Following surgery, the operative note stated that a ruptured ectopic pregnancy was identified in the right fallopian tube. Subsequently, a tubal resection and total salpingectomy were performed to correct the medical emergency.