Rupture of Ectopic Pregnancy With Negative Serum β-hCG Leading to Hemorrhagic Shock

BACKGROUND: Rupture of a fallopian tube caused by ectopic pregnancy may have serious consequences including hemorrhagic shock. The diagnosis of ectopic pregnancy is based on the demonstration of pregnancy using serum beta-hCG assays. Thus, a negative test usually allows the exclusion of the diagnosis of ectopic pregnancy. CASE: We present an unusual case of ectopic pregnancy resulting in hemorrhagic shock despite negative results for serum beta-hCG tests. Computed tomography and ultrasound scans revealed hemoperitoneum and a right adnexal mass. Medical management and laparoscopic salpingectomy allowed for a favorable outcome. CONCLUSION: This case illustrates the potential for an ectopic pregnancy to rupture with undetectable serum beta-hCG levels. Further, it illustrates the helpful role of imaging exams in diagnosing a patient with unstable hemodynamic status.