Ruptured Ectopic Pregnancy with Negative Urine Pregnancy Test

Study Objective To report a case of a ruptured ectopic pregnancy in a patient with a negative urine pregnancy test. Design Case report. Setting Academic center. Patients or Participants The patient is a 23yo sexually active G1P0 at approximately 7 weeks gestational age who presented to the Emergency Department (ED) with abdominal pain and vaginal bleeding. She reported having a positive urine pregnancy test at home 6 days prior to presenting to the ED. However, in the ED her urine pregnancy test was negative. Transvaginal ultrasound demonstrated no intrauterine pregnancy and a complex mass with heterogeneous echotexture in the left adnexa measuring 1.7 × 2.3 × 2.6 cm with surrounding hyperemia. No clear gestational sac seen in the left adnexa. There was also noted to be a moderate amount of free fluid in the posterior cul-de-sac. Interventions Diagnostic laparoscopy with left salpingectomy. Measurements and Main Results The patient's urine pregnancy test was negative and serum b-hCG level was 19.8. Her hemoglobin dropped from 15.3 to 13.5 over the course of two hours. Diagnostic laparoscopy revealed approximately 200cc of clotted blood in the pelvis, but no evidence of active bleeding. Her left fallopian tube was minimally adherent to the pelvic sidewall and an ectopic pregnancy was noted within the left fallopian tube. Right fallopian tube bilateral ovaries appeared normal. Final pathology was consistent with chorionic villi. Conclusion The diagnosis of an ectopic pregnancy can be challenging. It is important to maintain a high clinical index of suspicion for an ectopic pregnancy even in the case of a negative urine pregnancy test.