Page 11 - OB Risks - Delivering the Goods (Part Two)

SVMIC Obstetrics Risks: Delivering the Goods

C A S E S T U DY

The patient was a 28-year-old registered nurse (RN),
gravida 3, para 2, with a history of depression and

hyperthyroidism who was on propylthiouracil until the
pregnancy. She had a history of gestational hypertension

as well as obesity and two previous C-sections. On
May 20th, she presented to the emergency room with

abdominal and pelvic pain and bleeding for approximately
one week. Based upon the date of her last menstrual

period, the patient was admitted with a differential
diagnosis of “ectopic pregnancy vs. spontaneous AB”.

However, an ultrasound was done which revealed a
gestational sac in the uterus measuring 9 mm. There

was no fetal pole visible, but the radiologist who read the
ultrasound recommended a repeat ultrasound and repeat

HCGs. The patient was admitted, and on May 21st, her
pain acutely worsened and an exploratory laparoscopy

was performed by a surgeon. The source of the patient’s
pain was not discovered, but the surgeon removed the

appendix because it felt firm on examination. 20

On post-op day one, May 22nd, the patient’s HCG level was

6.284 and Progesterone was down to 6 from 7. Her previous
HCG level was 5.000. The OB concluded without further

investigation that the patient had an ectopic pregnancy
even though the laparoscopy was negative. The patient

was told by the OB that the HCG and progesterone levels
were not consistent with a normal intrauterine pregnancy.

Methotrexate was discussed with the patient and, upon
receiving consent, given to treat the ectopic pregnancy.

20 http://www.afp-digital.org/afp/may_15_2020/MobilePagedArticle.
action?articleld=1587926#articled1587926

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