OB/GYN
A 35-year-old woman is complaining of severe abdominal pain.
She is a known case of primary infertility and underwent embryo transfer 3 weeks ago (see lab results). Which of the following is the most likely diagnosis?
الشرح
Core Concept: Assisted reproductive technologies (ART), such as IVF and embryo transfer, carry an increased risk of ectopic pregnancy and heterotopic pregnancy compared to spontaneous conception. Severe abdominal pain 3-5 weeks post-transfer is highly suspicious.
Clinical Presentation:
- Unilateral or diffuse severe lower abdominal pain
- Vaginal spotting, shoulder tip pain (if ruptured with hemoperitoneum), and hemodynamic instability
Diagnosis:
- First-line diagnostic plan: Quantitative serum beta-hCG and transvaginal ultrasound to locate the gestational sac.
- Gold standard: Visualization of an extrauterine gestational sac with a yolk sac or fetal pole, or an empty uterus with an hCG above the discriminatory zone.
Management:
- Acute management: Hemodynamic stabilization and urgent evaluation for rupture.
- Gold standard long-term management: Medical management with methotrexate (if stable and unruptured) or emergency surgical intervention (laparoscopic salpingectomy/salpingostomy) if ruptured or contraindicated for medical therapy.