Obstetrical emergency: an unusual case of an ectopic pregnancy.

Proc (Bayl Univ Med Cent) 2012;25(1):73–75 A 21-year-old African American woman presented to the emergency department with a 3-week history of heavy vaginal bleeding; she had experienced varying amounts of bleeding but never needed more than a pad per hour. She was known to be less than 12 weeks pregnant but was unsure of the date of her last menstrual period. She was gravida 3 and parity 2, with a spontaneous vaginal delivery approximately 5 years earlier and an “abdominal” (presumed ectopic) pregnancy removed by laparotomic surgery 5 months earlier at an outside institution. Other medical history included hypertension, depression, bipolar disorder, and surgery for a “hernia repair.” All laboratory values were within normal limits, and her human chorionic gonadotropin level was 8009 mIU/mL. Diff erential considerations at this time were threatened or spontaneous abortion and recurrence of ectopic pregnancy. Upon transvaginal sonography, a bicornuate uterus was identifi ed (Figure 1). No adnexal abnormalities were appreciated. Within the right cornua, a gestational sac, yolk sac, and fetal pole were identifi ed and diagnosed as a cornual ectopic pregnancy (Figure 2). Fetal heart tones measured approximately 120 beats per minute. No appreciable myometrium surrounded the gestational sac (Figures 3 and 4). Th e left cornua demonstrated a thick endometrium, most likely related to hyperestrogenemia from a pregnant state, without any other abnormality.