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:
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.
Ruptured ovarian cyst
Ruptured ectopic pregnancy
Red degeneration of fibroid
Pelvic abscess
Ecotopic Pregnancy