Abstract
Ectopic pregnancy has been increasing in frequency over the past 2 decades. The sudden rupture of ectopic pregnancy can lead to haemorrhagic shock and death if not diagnosed and treated in a timely fashion. The first step in the diagnosis of ectopic pregnancy is demonstration of pregnancy by means of a rapidly performed and sensitive qualitative urine test for the beta-subunit of human chorionic gonadotropin (beta-hCG). This case report demonstrates the importance of further consideration of the diagnosis of ectopic pregnancy in the setting of an unusual presentation like per rectal bleed and amenorrhea for three years in the presence of Mirena.
Highlights
The incidence of ectopic pregnancy has increased and the proportion of maternal deaths attributable to ectopic pregnancy increased from 6% - 10% during the same period
Ectopic pregnancy should be suspected in every woman of reproductive age who presents with unexplained abdominal pain, a pregnancy test should be first line of investigation with serum beta HCG, irrespective of amenorrhea and vaginal bleeding
It cannot be over emphasized that early diagnosis is of paramount importance. As illustrated in this case, diagnosis can be missed in the absence of classical symptoms of ectopic pregnancy compounded by incomplete patient assessment
Summary
The incidence of ectopic pregnancy has increased and the proportion of maternal deaths attributable to ectopic pregnancy increased from 6% - 10% during the same period. Ectopic pregnancy should be suspected in every woman of reproductive age who presents with unexplained abdominal pain, a pregnancy test should be first line of investigation with serum beta HCG, irrespective of amenorrhea and vaginal bleeding. A delay or error in the diagnosis of ectopic pregnancy leads to increased risk of mortality and morbidity. A pregnancy test with a transvaginal scan and β-HCG would improve the likelihood of an early and accurate diagnosis, facilitating prompt treatment
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