Basanti, a 28 years aged female with a history of 6 weeks of amenorrhoea presents with pain in abdomen; USG shows fluid in pouch of Douglas. Aspiration yields dark color blood that fails to clot. Most probable diagnosis is:
Ruptured ovarian cyst
Ruptured ectopic pregnancy
Red degeneration of fibroid
Pelvic abscess
Ans. is b, i.e. Ruptured ectopic pregnancyRef. Dutta Obs. 7/e, p 182; Williams Obs. 22/e, p 258, 259, 23/e, p 242, 243The picture given in the question classically represents a case of ruptured ectopic pregnancy.The women in the question is presenting with amenorrhea of 6 weeks and pain in abdomen.On USG - fluid is seen in POD and aspiration of dark coloured blood which fails to clot - all these features leave no doubt of ectopic pregnancy."Sonographic absence of uterine pregnancy, a positive pregnancy test (b-hCG), fluid in cul-de-sac and an abnormal pelvic mass, ectopic pregnancy is almost certain--Williams Obs. 22/e p 259Also Know:D/D of fluid in POD:1. Mid cycle2. PID3.Tubal abortion (ectopic)Culdocentesis:It is a simple technique used to identify hemoperitoneum.Fluid is aspirated from cul-de-sac via posterior fornix with the help of a needle.If non clotting blood is obtained, it is indicative of an intraperitoneal bleed and probably a ruptured ectopic.Note: If the aspirated blood clots, it may have been obtained from an adjacent blood vessel rather than from bleeding ectopic pregnancy.
Ecotopic Pregnancy