In The Spot

A 33 year old woman presents at 8 weeks of her first gestation complaining of cramping lower abdominal pain for 2 days, in a background of vague pelvic pain for the last week.

She received in-vitro fertilization (IVF) to become pregnant, following 3 years of primary infertility attributed to asthenozoospermia in her husband. A total of 4 embryos were implanted.

A transvaginal ultrasound scan performed at 6 weeks of gestation revealed a single live intrauterine pregnancy, while a serum beta-hCG assay was found to be 10,200 mIU/ml

Select Relevant Investigations
Full Blood Count

Performed

WBC/DC: 9,000/mm3
Hb: 12.5 g/dL
Hematocrit (PCV): 34%
Platelets: 260,000/mm3
Abdominal + Pelvic Ultrasound

Performed

The abdominal ultrasound scan reveals a moderate amount of echogenic free fluid in the pouch of douglas.
Transvaginal scanning reveals a 30 mm intrauterine gestational sac with cardiac activity; another gestational sac of 25 mm with cardiac activity and a hyperechoic rim is noted in the right fallopian tube, close to the right ovary.
Serum beta-hCG

Performed

The serum beta-hCG is 35,600 mIU/ml.
GC+CT NAAT

Performed

Negative for both gonococcus and chlamydia.

Select Relevant Management
Laparoscopy
Doxycycline
Methotrexate
Blood Transfusion