A Case Report of Ruptured Ectopic Pregnancy with Negative HCG -beta Test

Although 1% to 2% of all pregnancies are ectopic, ectopic pregnancy (EP) is the most frequent obstetrical disease leading to maternal mortality and morbidity in the first trimester. The basic diagnostic method for EP is the human chorionic gonadotropin (HCG) test and transvaginal ultrasound. There are some rare EP cases with a negative HCG -beta test.

A 31-years-old woman was referred to the emergency department with hypogastric, periumbilical, right upper quadrant intermittent pain, vaginal bleeding, and prior history of EP 7-months ago that was treated with methotrexate and her intrauterine device had been removed at that time. Her last menstrual period was undetermined. Although the qualitative HCG- betatest was negative (2.08 IU /ml), the ultrasound examination showed an 43×53 mm echogenic, heterogenic complex solid mass in the left adnexa and a large amount of echogenic fluid demonstrating hemoperitoneum. Surgery because of the exceeded abdominal pain, revealed active bleeding in the left salpinx due to a ruptured EP.

Management of patients suspected of EP with a negative HCG-beta test is difficult. In these uncommon cases in an emergency, computed tomography, ultrasound and diagnostic laparoscopy or laparotomy can improve the prognosis of the patient.