Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
A 23-year-old woman, gravida 2, para 0, has had vaginal spotting and abdominal cramps for 2 days. Her last menstrual period was 8 weeks ago. A home pregnancy test was positive 2 weeks ago. She underwent a salpingectomy 4 years ago following an ectopic pregnancy. Examination shows a closed cervix, an enlarged uterus, and no adnexal masses. Transvaginal ultrasonography shows an empty uterus. Serum ß-hCG level is 8000 mIU/mL.
A) Abortion of a blighted twin
B) Cervicitis
C) Ectopic pregnancy
D) Focal decidual necrosis
E) Gestational trophoblastic disease
F) Incomplete abortion
G) Ovarian torsion
H) Ruptured ovarian cyst
I) Threatened abortion
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
I think it is C, but can not rule out option A, any idea?
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
AA
no adenexal masses. I think CC is not the choice
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
why A? plz explain. I would have thought between C or E. With positive beta HCG, and no adnexal masses, and ESPECIALLY ENLARGED UTERUS, E is more likely to me. It seems she has been pregnant at least 6 weeks (urine hcg detected around 4 weeks) so why would transvaginal not pick up gestational sac or POC if it was A.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
I was thinking of A too, but maybe close cervix rules it out.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
Answer is C. ectopic pregnancies are most common in the adnexa, but can be elsewhere as well (even in the abdomen). Bleeding, ultrasound with no IUP and hcg >1500 is diagnostic of an ectopic. adnexal tenderness is almost always present, but not in this case. dont let that stear you away from the other clues.
Its not GTD because ultrasound would show a snowstorm appearance, not empty sac.
Its not incomplete abortion because she has a closed cervix
Ovarian torsion should not increase hcg, just causes severe pain
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
Oh yea, and not A because if she aborted a blighted twin, she would have an opened cervix and present with more than just spotting (products of conception would have passed through). Furthermore, twins have much higher hcg's.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
thanks drjeggy, you analyze the question very well.good luck
