- A mother went to the hospital with a bleeding when she was 6 weeks pregnant. It looked like she had a miscarriage.
- Weeks later, she experienced a ruptured ectopic pregnancy — despite negative pregnancy tests.
- “Chronic ectopic pregnancies” are rare and can be particularly difficult to diagnose.
A mother in her 30s suffered a ruptured ectopic pregnancy — though a urine pregnancy test came back negative, a new case report describes.
The woman, a mother of three, went to a British hospital with severe bleeding when she was about six weeks pregnant.
A blood test confirmed the pregnancy, but an ultrasound did not detect a bag. So clinicians kept a close eye on her to see if she was just getting into the pregnancy earlier than she thought — or if something else was going on, like a miscarriage or ectopic pregnancy.
Over the course of a few days, one of the latter options seemed most likely. Maternal beta-human chorionic gonadotropin (bHCG) levels — which pregnancy tests pick up — dropped, suggesting miscarriage. And yet an ultrasound suggested an ectopic pregnancy.
So doctors continued to monitor the patient with blood work and ultrasound every 48 hours. They did not intervene further because her blood pressure was normal, she had no pain and her bHCG levels were so low, Dr. Louise Dunphy, the lead author of the case report, a gynecologist at Leighton Hospital in Crewe, told Insider.
When she was about 10 weeks pregnant, the woman started experiencing severe pain on her right side. At this point, her urine pregnancy test was negative, but a blood test was positive. Further tests revealed a ruptured ectopic pregnancy and “an urgent assessment of anesthesia and gynecology was requested,” the study authors wrote.
The woman underwent surgery to remove her right fallopian tube and the pregnancy tissue. All told, according to the study, she lost about 2,050 milliliters of blood and needed a transfusion. She was fired after three days.
Dunphy told Insider there isn’t enough awareness around chronic ectopic pregnancies, which describes an ectopic pregnancy with bHCG levels so low that it won’t show up with a urine test. “This case demonstrates the importance of requesting a blood test,” she said.
Chronic ectopic pregnancies are “a mystery,” study authors say
An ectopic pregnancy is when a fertilized egg implants somewhere other than the uterus — usually in a fallopian tube. The pregnancy is never viable and prompt treatment is critical to prevent the tube from bursting and leading to potentially life-threatening internal bleeding.
While ectopic pregnancies are usually detectable by urine pregnancy tests, in 1.6% of cases they are only detectable through blood tests, the study said. “It’s a mystery,” the study authors write, adding that only a few reports of chronic ectopic pregnancies have been published in the past decade, and many of them were discovered as a result of an unrelated intervention.
Chronic ectopic pregnancies — which doesn’t actually mean “chronic” as it does with persistence — are thought to occur when an ectopic pregnancy causes small, repeated ruptures that develop into a mass of blood, clots, and trophoblastic tissue, or the tissue that develops into the develops the placenta and produces the bHCG hormone.
In these cases, it appears that the trophoblastic tissue is not producing enough bHCG to be picked up by urine pregnancy tests, which only detect pregnancies when bHCG levels are above 25 IU/L. But anything of 5 IU/L or more is a pregnancy, Dunphy said.
Chronic ectopic pregnancies can be particularly difficult to diagnose because their symptoms — such as pelvic pain, bleeding irregularities, or sometimes no symptoms at all — can mimic other, more common conditions you’d expect in someone with a negative pregnancy test.
For example, a chronic ectopic condition can be misdiagnosed as a ruptured appendix, ulcer, pelvic inflammatory disease, or urinary tract infection. But “prompt diagnosis is important,” the study authors say, because the chronic type, like ectopic pregnancies, can rupture the fallopian tube and become life-threatening.