![]() ![]() These cases and ours suggest that ectopic pregnancy should be considered even with a negative pregnancy test. These patients were taken to the operating room for suspected hemoperitoneum ( 5). Since 1987, eight cases of ruptured ectopic pregnancy have been reported with a negative urine pregnancy test. ![]() The patient's history of ectopic pregnancy and physical exam prompted surgical management despite a negative pregnancy test.ĭaniilidis et al described similar findings. In the case described herein, however, ultrasound findings were concerning for hemoperitoneum. Commonly in ectopic pregnancy, the hCG is elevated and increases abnormally, rising <53% in 48 hours ( 4). A combination of ultrasound and hCG has a 96% sensitivity and 97% specificity for ectopic pregnancy ( 1). The condition is diagnosed by a transvaginal ultrasound and elevated hCG, as recommended by the American Congress of Obstetricians and Gynecologists ( 2, 3). Ruptured ectopic pregnancy was suspected despite a negative pregnancy test.Įctopic pregnancies in which the zygote is implanted outside the endometrial cavity comprise 2% of all pregnancies ( 1) and often present with vaginal bleeding or abdominal pain. An ultrasound showed a normal uterus and a 4 × 2.6 × 4.6 cm heterogeneous right adnexal mass with free fluid ( Figure 1). A urine pregnancy test was negative, and a serum hCG of 15 mIU/mL was within normal limits. Laboratory studies showed a white blood cell count of 5.9 K/uL hemoglobin, 10.9 g/dL and hematocrit, 33.8%. The speculum examination revealed scant white discharge without bleeding. Bimanual examination revealed cervical motion tenderness and right adnexal and uterine tenderness. There was tenderness to palpation in the left and right lower quadrants with voluntary guarding, but no distension or rebound tenderness. Her temperature was 98.6☏ heart rate, 99 beats per minute blood pressure, 124/60 mm Hg respiratory rate, 14 breaths per minute and oxygen saturation, 99% on room air. On exam she was awake, alert, and in no distress. She had been sexually active after her diagnosis and took oral contraceptives, and her partner wore condoms. During the 2 weeks before admission, her hCG levels had gradually declined but had not reached zero. Due to an inappropriate rise in hCG, she had been given methotrexate. Three weeks earlier she was diagnosed with possible ectopic pregnancy. If you think you might be pregnant, Your Options Medical can offer you pregnancy testing, ultrasound, and pregnancy options counseling at no cost to you and insurance is not required.A 25-year-old gravida 2 para 0 female with a history of ectopic pregnancy presented to the emergency department with sharp, right lower abdominal pain for 24 hours associated with near syncope. If you think you might be pregnant because you have missed your period, know that there are other reasons besides pregnancy. tubes tied), are experiencing pregnancy-like symptoms, and test negative on a pregnancy test, contact your medical doctor to assess for causes unrelated to pregnancy. If the test is left beyond the recommended set time, this could produce a false test result. ![]() ![]() Most pregnancy tests require you to let the test set for 3-5 minutes. It is important to follow the manufacturer’s instructions.
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