Unruptured Right-Sided Ectopic Pregnancy: A Case Report at a Public Hospital in Tuxtla Gutiérrez, Chiapas

Abstract

Introduction: Ectopic pregnancy consists of the implantation of the blastocyst outside the endometrial cavity, occurring in the Fallopian tubes in the majority of cases. With an incidence of 1-2%, it represents a critical obstetric emergency if not diagnosed timely. Risk factors such as pelvic inflammatory disease and previous surgeries increase its prevalence. Currently, early detection through ultrasonography and $\beta$-hCG quantification allows for conservative management strategies that preserve reproductive potential.

Case description: A 32-year-old female patient presented to the emergency department reporting a three-day history of colicky abdominal pain in the hypogastrium and right iliac fossa, associated with scant transvaginal bleeding and seven weeks of amenorrhea. Physical examination revealed the patient was hemodynamically stable, with a blood pressure of 90/60 mmHg. Bimanual gynecological examination identified a palpable right adnexal mass. Laboratory findings reported a serum β-hCG of 4,200 mIU/mL and hemoglobin of 10.2 g/dL. Transvaginal ultrasonography evidenced a vacant uterus and an image compatible with a 1.8 cm gestational sac in the right adnexa, accompanied by a moderate amount of free fluid in the pouch of Douglas. A diagnosis of unruptured right tubal ectopic pregnancy was established. Due to hemodynamic stability, medical management was initiated with a single intramuscular dose of methotrexate (50 mg/m²). The patient showed a favorable clinical evolution, with a progressive and sustained decrease in β-hCG levels.

Conclusions: Timely diagnosis of ectopic pregnancy enables conservative management with methotrexate in selected patients, mitigating surgical morbidity and preserving reproductive potential. The correlation of clinical, biochemical, and sonographic findings is fundamental to ensuring effective intervention and favorable maternal outcomes.