ABSTRACT
A 34-year-old patient had her first trimester Down syndrome scan followed by serial ultrasound scans which showed a single intrauterine pregnancy with multiple cystic areas in the anterior placenta. She presented in preterm labour with a breech presentation at 32 weeks and underwent an emergency caesarean section. She delivered a male infant weighing 1750 g. The placental histopathology showed a complete hyatidiform mole. At 4 weeks postpartum, beta-human chorionic gonadotrophin (Bhcg) levels rose from 460 to 836 mIU/mL over 1 week. Metastatic workup revealed prominent pelvic nodes and pulmonary nodules in both lungs. This was discussed at the Multi-Disciplinary Tumour Board and single-agent intramuscular methotrexate was recommended. After chemotherapy, she achieved Bhcg normalisation after three cycles. This case highlights the importance of clinical vigilance even in low-risk patients. Unexpected findings on ultrasound should involve multidisciplinary input with radiology colleagues. A high index of suspicion for gestational trophoblastic disease and close follow-up is imperative.
Subject(s)
Antimetabolites, Antineoplastic/therapeutic use , Gestational Trophoblastic Disease/diagnosis , Lung Neoplasms/diagnosis , Methotrexate/therapeutic use , Uterine Neoplasms/diagnosis , Adult , Female , Gestational Trophoblastic Disease/drug therapy , Humans , Hydatidiform Mole/diagnosis , Hydatidiform Mole/drug therapy , Infant, Newborn , Lung Neoplasms/drug therapy , Male , Pregnancy , Uterine Neoplasms/drug therapyABSTRACT
We report a 35-year-old female patient with a history of bilateral salpingectomy from ectopic pregnancies presenting with a positive serum beta-human chorionic gonadotropin (bhCG) result following in vitro fertilisation (IVF) treatment. Apart from per vaginal spotting, she remained asymptomatic. Initial ultrasound showed an empty uterus with a cystic mass on the right side of the uterus. Serum beta-hCG was trended. A follow-up pelvic ultrasound 1 week later showed a live pregnancy in the right adnexa. A diagnostic laparoscopy was performed, which revealed an unruptured right stump ectopic pregnancy that was successfully removed. As a stump ectopic pregnancy can be a potentially life-threatening occurrence, we emphasise caution with salpingectomy and the consideration of tubal stump ectopic pregnancies following IVF treatment.
Subject(s)
Pregnancy, Tubal , Salpingectomy , Adnexa Uteri/diagnostic imaging , Adult , Chorionic Gonadotropin/blood , Female , Fertilization in Vitro , Humans , Laparoscopy , Pregnancy , Pregnancy, Ectopic/surgery , Pregnancy, Tubal/diagnostic imaging , Pregnancy, Tubal/surgery , UltrasonographyABSTRACT
We present a case of primary omental ectopic pregnancy in a 31-year-old woman which was discovered intraoperatively during a diagnostic laparoscopy and subsequently removed via mini-laparotomy. We emphasise the rarity of this diagnosis, and the importance of careful inspection of the abdominal cavity including the omentum should an ectopic pregnancy be suspected when bilateral fallopian tubes and ovaries appear normal during surgical exploration.
