Very early diagnosis of tubal unruptured pregnancy: the role of echography in urgency for early surgical resolution

Abstract

AIM: TO emphasize the role of clinical suspect and echographic approach to heterotopic pregnancy in young women complaining of acute abdominal pain

MATERIAL OF STUDY: Tubal pregnancy in a young woman has been reported. Diagnostic clinical suspect, also supported by serum hormonal substances (beta HCG), has been confirmed by US in urgency; transabdominal investigation requires skilled operator, preferably surgically trained, to identify early stady of heterotopic pregnancy (fifth week of gestation), which has undergone left salpingectomy in our experience.

RESULTS: The early diagnosis of unruptured tubal pregnancy in our experience prevented hemorragic shock and other potential fatal complications, usually occurring in this condition.

DISCUSSION: Ectopic pregnancy is a life threatening condition, rarely occurring during natural cycle; however its incidence is increasing, considering the wider and wider use of assisted reproductive techniques and of gynecological surgical diagnostic and therapeutic procedures. The rupture of ectopic part causes acute abdomen and potentially fatal hemorrhage, whose only solution relies on surgical operation in urgency.

CONCLUSIONS: Clinical and anamnestic evaluation, ultrasonography and serum gonadotropin concentration are the first choice approach to fertile women suffering from abdominal recurrent pain, when no other causes are suspected. The heterotopic tubal pregnancy described is a very rare condition; in spite of early diagnosis, radical surgery consisting in left salpingectomy has been the only surgical feasible option, patient’s life-sparing.