A life-threatening condition-ruptured ectopic pregnancy with negative urine pregnancy test: A case report

Keywords: ectopic pregnancy, negative urine pregnancy test, ruptured ectopic, reproductive women Abstract Ectopic pregnancy is an extra-uterine pregnancy and is a potentially life-threatening condition that can lead to death from intra-peritoneal hemorrhage. Another issue in this case was the falsenegative UPT that misled the doctor in ruling out EP. β-hCG is detectable in urine and serum within 16 days following the luteinizing hormone surge.6 In normal pregnancies, the serum β-hCG level doubles every 48 to 72 hours but in EP, it increases at a lesser rate.1 A study done among women with EP showed that the increment of β-hCG was only 75% after 48 hours compared to 124% in a viable pregnancy7 and it declined at the same rate or faster than those with complete abortion, such that the results could be interpreted as "normal" for a complete abortion.7 A defect in the biosynthesis of ß-hCG in an ectopic trophoblast may also cause a false-negative result. TAS is widely available in primary care; however, it has little benefit in the early stages of EP as the diagnostic reliability of TAS is only 70% compared to > 90% for TVS.2 TAS may only be able to visualize the presence of free fluid and an empty uterus.2 Therefore, the ability to perform TVS should be recommended to be part of the Credentialing and Privileging program among the primary care doctors that may aid the diagnosis of EP Ruptured EP is a clinical diagnosis with clinical features such as sudden and persistent abdominal pain that may be accompanied by shoulder pain, peritonitis, or shock.1,10 In this case study, the patient had a compensated hemorrhagic shock as evidenced by tachycardia, normotension, and hemoperitoneum. How does this paper make a difference to general practice? * A flaw in the diagnostic workup of this case was that the exclusion of EP was solely based on the negative UPT result. * EP should be suspected and UPT should be mandatory in all sexually active women with lower abdominal pain, amenorrhea, and/or vaginal bleeding. * Negative UPT with high suspicion of EP should be managed as an emergency until proven otherwise.