BEWARE OF ATYPICAL PRESENTATION OF ECTOPIC PREGNANCY

Ectopic pregnancy is one of the major causes of obstetric emergencies, accounting for 2% of pregnancies. The classical presentation includes triad of abdominal pain, vaginal bleeding and amenorrhea which is seen in 60 % of cases only. The other 40% of cases with atypical presentation lead to diagnostic challenge. Here we present a series of three cases of ectopic pregnancies with atypical presentation, to emphasis on the need of clinical judgment to diagnose ectopic pregnancy. Case one was a parous lady, who presented with gastro-enteritis to the medical department and was treated for the same. Ultrasound showed ascites. CT abdomen showed right adnexal mass. Meanwhile patient was referred to the department of gynecology, where ectopic was diagnosed clinically through meticulous history, clinical examination, culdocentasis and a weakly positive pregnancy test. Emergency laparoscopic right salphingectomy was done. Second case was a parous woman, who had been sterilized, presented with complaints of pain abdomen and with an ultrasound and MRI report done elsewhere with an impression of pregnancy in one horn of bicornuate uterus and free fluid abdomen. Clinical examination revealed tender right adnexal mass. Ruptured ectopic pregnancy was diagnosed. Emergency laparotomy and right salphingectomy was done. Third case was a young woman who presented with a history of two months amenorrhea and complaints of passing fleshy mass suggestive of complete abortion. Per vaginal examination revealed a right adnexal mass. Ultrasound showed 2.2 x 1.7 cm right adnexal mass and beta hCG was 8000 IU/dl. She was successfully managed medically.