Divine Word Hospital

DEPARTMENT OF
OBSTETRICS AND GYNECOLOGY

SGD #5

Date of consult: December 18, 2020

FS, a 28-year old G1P0 sought consult at the DWH Emergency Room for left lower quadrant
pain. She was apparently well until five days prior to consult when she started to have
vaginal spotting minimally staining 1 pantyliner per day. No other symptoms were noted
hence no consult done. A day prior to consult, there was pain on the left lower quadrant,
VAS 5/10 unrelieved with Buscopan. Persistence of the left lower quadrant pain now noted
to worsen prompted consult. Patient has no known co-morbidities and no previous
surgeries. She had her menarche at 12 years old, with subsequent menses occurring at
regular monthly intervals. Last normal menstrual period was on October 14-17, 2020. She
had pregnancy test done after her missed menses in September showing a positive result.
However, no prenatal check-up nor ultrasound done due to lockdown in their area. She
works as a teacher, has no vices, and no history of contraceptive use. She only had 1 lifetime
sexual partner who is her police husband with whom she had been married for 3 years now.

At the emergency room, BP 100/60 HR 94 RR 20 Temp 36.8C O2Sats 99%

HEENT: essentially normal

Abdomen was soft, flat, no guarding, but with direct tenderness on the left lower quadrant

On speculum exam, vaginal walls pink and smooth, cervix pink with no blood nor gross
lesion

On internal examination, she had normal external genitalia, nulliparous vagina, cervix
smooth closed with no cervical motion tenderness, corpus small, (+) 5 x 4 cm left adnexal
mass tender on deep palpation

On rectovaginal exam, good sphincter tone, intact rectal vault, no fullness in the cul de sac

PREGNANCY TEST: +
 Divine Word Hospital
DEPARTMENT OF
OBSTETRICS AND GYNECOLOGY

TRANSVAGINAL ULTRASOUND:

No intrauterine GS seen
Endometrium decidualized 1.8 cm thick
There is an extrauterine gestation seen on the left adnexa with fetal pole and fetal cardiac
activity (FHT = 140s)
Both ovaries normal with corpus luteum on the left
There is minimal free fluid in the cul de sac
IMPRESSION: Ectopic pregnancy, left, probably ruptured

INTRAOPERATIVE FINDINGS: