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Journal of Postgraduate Medicine, Vol. 57, No. 3, July-September, 2011, pp. 223-224 Case Snippet Face to face: Misplaced intrauterine device and abdominal ectopic pregnancy SV Parulekar Department of Obstetrics and Gynecology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India PMID: 21941064 DOI: 10.4103/0022-3859.85217 A 22-year-old married gravida 2 para 1 woman presented with 5 weeks of amenorrhea and mild pain in the lower abdomen for 2 days. Her past menstrual cycles had been every 28 days, regular, and moderate in flow. She had a normal delivery 2 years ago. She had a Copper T intrauterine device (IUD) in the uterus. Her past medical and surgical history was not contributory. Her general examination revealed no abnormality. The abdomen was soft. Speculum examination showed the cervix to be congested. Threads of the IUD were absent. On bimanual pelvic examination there was no pelvic tenderness, the uterus was of normal size and the adnexae were not palpable. There was no pelvic mass. A pregnancy test on urine was positive. Pelvic ultrasonography showed the uterus to be empty, the adnexae normal, and the IUD on right side of the uterus. Serum beta hCG was 1250 mIU/ml. The test was repeated after 48 h, when the value was 1365 mIU/ml. A diagnosis of an ectopic pregnancy was made and the patient was offered surgical treatment by laparoscopy along with removal of the misplaced IUD. The IUD was found to be in the right broad ligament, with its lower end projecting from the posterior leaf of the broad ligament. An ectopic pregnancy was found implanted on the back of the right broad ligament away from the right tube and ovary [Figure - 1]. The IUD and the ectopic pregnancy were removed using grasping forceps passed through an accessory port. The patient made an uneventful recovery. Her beta hCG level was found to be zero, 1 week after the procedure. A very early primary abdominal ectopic pregnancy has not yet been documented photographically yet in the world literature. The only documentation is of an intrauterine implantation of the blastocyst. [1] This patient would have been treated satisfactorily by observation alone or with methotrexate therapy. [2] However, the misplaced IUD had to be removed and, hence, there was no option to performing a laparoscopy. The ectopic pregnancy could be documented only because of the laparoscopy. The image is presented because such pictures are unlikely to be available with modern methods of treatment of early ectopic pregnancies. References
Copyright 2011 - Journal of Postgraduate Medicine The following images related to this document are available:Photo images[jp11061f1.jpg] |
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