title: A painless pelvic wall ectopic pregnancy.
abstract: A 38-year-old woman presented with light vaginal bleeding at approximately 8 weeks gestation. Although she initially presented to accident and emergency with vaginal bleeding and menstrual-like pain, this rapidly settled and both symptoms resolved over the following days. An initial ultrasound scan revealed an empty uterus, with no adnexal masses or free fluid. Miscarriage was presumed. However, following suboptimal β-human chorionic gonadotropin decline, further ultrasonography noted a mass next to the right ovary. The patient underwent laparoscopy, revealing an ectopic pregnancy closely adherent to the peritoneum of the right pelvic wall. The patient was treated with systemic methotrexate and responded well. This rare form of ectopic pregnancy has a high maternal morbidity and mortality, and its optimal management is not definitively decided, due to the scarcity of the condition and subsequent lack of high-powered data. We present a case of successful medical management.
authors.affiliation: Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, UK.
authors.forename: Zakk
authors.identifier: http://orcid.org/0000-0002-7402-7295
authors.initials: Z
authors.lastname: Borton
authors.affiliation: Queen Alexandra Hospital, Portsmouth, Hampshire, UK.
authors.forename: Alice G
authors.initials: AG
authors.lastname: Landon
authors.affiliation: Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, UK.
authors.forename: Savita
authors.initials: S
authors.lastname: Singh
mesh_terms: D034861:Abdominal Wall; D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008727:Methotrexate / Q000627:therapeutic use*; D017699:Pelvic Pain / Q000175:diagnosis* / Q000209:etiology; D010388:Pelvis; D010537:Peritoneum; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000188:drug therapy*; D014592:Uterine Hemorrhage / Q000175:diagnosis / Q000209:etiology
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate