A 34-year-old woman has had recurrent episodes of dull left pelvic pain for 2 months with occasional spotting. Beta-hCG is 45 mIU/mL. Ultrasound shows a 4 cm complex left adnexal mass separate from the ovary. At laparotomy the fallopian tube is distended, dark, and intact. Histopathology of the excised segment shows degenerating chorionic villi with old organised haematoma. Diagnosis:

• A Acute ruptured ampullary ectopic pregnancy
• B Chronic (tubal abortion) ectopic pregnancy ✓
• C Placental site trophoblastic tumour
• D Haemorrhagic corpus luteum cyst

Explanation

A chronic ectopic results when repeated small leaks of blood from the tube are contained and organised without catastrophic rupture. Trophoblast is largely degenerated, so beta-hCG is low or near normal, symptoms are indolent over weeks to months, and the tube forms a firm mass. Histology showing old clot with degenerated villi confirms it. An acute rupture would present with sudden severe pain, shock, and markedly elevated beta-hCG.

Reference: Shaw's Textbook of Gynaecology, 18th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.