Uncommon presentation of ectopic pregnancy with elevated β-hCG with no clinical symptoms: a case report

Background: Ectopic pregnancy is a nidation of the fertilized ovum outside the uterine cavity and is most commonly found in the fallopian tube. Hence, it is a primary contributor to maternal morbidity in the first trimester. Ectopic pregnancy can be influenced by numerous factors such as prior cesarean sections that lead to alterations in the anatomy of the pelvis and scarring. In all these cases, it is very critical to avert potentially life-threatening complications with an appropriate early diagnosis and management that could also preserve future attempts at conception. Case Presentation: A 29-year-old gravida 3, para 2 woman at 6 weeks and 2 days gestation presented with a suspected ectopic pregnancy. The patient had a history of two previous cesarean sections. There was a serious rise in serial β-hCG levels (48,000 mIU/ml); however, imaging showed a right adnexal mass with no signs suggesting a viable intrauterine pregnancy. Emergency laparoscopy confirmed a right tubal ectopic pregnancy, which was treated successfully in surgery with a right salpingectomy. She made an uneventful recovery and was discharged in stable condition, with instructions for follow-up and future pregnancy counseling. Conclusion: The case emphasizes the clinical consideration of ectopic pregnancy among women with cesarean section, notwithstanding the absence of classical presentation; however, the significant high β-hCG levels. It stresses the merit of serial β-hCG test, imaging, and laparoscopy in early diagnosis and management of ectopic pregnancy. Actual early intervention is envisaged to protect against any threatening posting and shall optimize outcome.