She denied vaginal bleeding. Physical exam revealed stable vitals, severe diffuse abdominal pain with guarding, cervical motion tenderness, and bilateral adnexal tenderness without palpable masses. Her hemoglobin had dropped from Figure 1 shows the repeat pelvic ultrasound images, demonstrating a large complex fluid collection in the pelvic cul-de-sac, possibly representing a hemorrhage without evidence of an intrauterine pregnancy.
Gestational tissue was identified during the surgery. Her postoperative recovery was unremarkable. Diagnosing a ruptured ectopic pregnancy with a negative urine pregnancy test is exceptionally rare and only a few cases have been reported in the literature [ 3 — 8 ]. The following list summarizes reported cases of ectopic pregnancies with negative urine pregnancy tests. Pabon et al. Nishijima et al. Brennan et al.
Grynberg et al. Daniilidis et al. The emergency physician must remain cognizant of this potential diagnosis in the setting of unexplained intraabdominal hemorrhage or severe pelvic pain with a negative urine pregnancy test [ 2 , 4 ]. Our case illustrates the ongoing clinical diagnostic challenges associated with ectopic pregnancy.
In the correct clinical setting, it is of importance not to exclude this potentially life-threatening diagnosis with a negative urine pregnancy test.
This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors.
Read the winning articles. Journal overview. Academic Editor: Vasileios Papadopoulos. Received 14 Jun JAMA 14 — Chard T Pregnancy tests: a review. Hum Reprod 7 5 — Am J Emerg Med 21 6 PubMed Article Google Scholar. Am J Emerg Med 23 1 Goh JT, Sidhu MS Ruptured tubal ectopic pregnancy associated with negative qualitative human chorionic gonadotrophin levels. Kalinski MA, Guss DA Hemorrhagic shock from a ruptured ectopic pregnancy in a patient with a negative urine pregnancy test result.
Ann Emerg Med 40 1 —5. J Emerg Med 19 3 — Obstet Gynecol 79 5 Pt 2 — Tulandi T, Hemmings R, Khalifa F Rupture of ectopic pregnancy in women with low and declining serum beta-human chorionic gonadotropin concentrations. Fertil Steril 56 4 — Obstet Gynecol 71 6 Pt 2 — A case report. J Reprod Med 32 7 — Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Fadi Alfhaily. Reprints and Permissions.
Alfhaily, F. Laparoscopic removal of a large 8-cm ectopic pregnancy with a negative pregnancy test. Gynecol Surg 6, — Create a personalised content profile. Measure ad performance. Select basic ads. Create a personalised ads profile. Select personalised ads. Apply market research to generate audience insights. Measure content performance.
Develop and improve products. List of Partners vendors. If you've missed your period but get a negative pregnancy test result, you may be feeling confused. Are you pregnant? If not, then why haven't you gotten your period?
First off, don't panic. There are several reasons you can miss a period and not get a positive pregnancy test—including a false negative result. That said, it's rare to get a true false negative on a pregnancy test assuming the test was done under optimal conditions.
Here are some of the more likely explanations:. Getting a negative result when you otherwise would expect a positive one can be stressful and emotionally challenging. Most of the time, the uncertainty will resolve in a few days. You'll either get your period or you'll take another test and discover that you are pregnant.
Less often, something is wrong—but this is rare. Here's an overview of some of the reasons for a negative pregnancy test when you've missed your period. Watch all episodes of our Stay Calm Mom video series and follow along as our host Tiffany Small talks to a diverse group of women and top doctors to get real answers to the biggest pregnancy questions.
A false negative pregnancy test is when you are pregnant but the test comes up negative. The most common reason for a false negative is that you took the test too early. Even if your period is late according to your typical cycle, you might have ovulated later in the month. It's not uncommon to occasionally have an off or irregular cycle.
Additionally, your count of when your last period occurred could be a few days off. No matter how sensitive the test, you won't get a positive home pregnancy test until enough days have passed since ovulation and conception and your body has had time to build up enough of the hormone the test detects.
If ovulation occurred later in the month, you will need to test later. There are many reasons you might ovulate later than you typically do. Pregnancy tests look for the pregnancy hormone hCG , which increases as a pregnancy progresses. The normal range for hCG levels in pregnant people can vary widely. An early pregnancy test might pick up very low amounts of hCG. How much hCG you have isn't important; rather, it's how quickly your levels double and increase and this can only be measured with a blood test.
Another common reason for getting a false negative is not having enough hCG in the urine you test. In early pregnancy, you can dilute the hormone concentration in your urine if you drink a lot of water before testing. This is more likely to happen in very early pregnancy when you take the test later in the day. A false negative can also occur due to test error. It usually has to be removed using medicine or an operation. In the UK, around 1 in every 90 pregnancies is ectopic.
This is around 11, pregnancies a year. An ectopic pregnancy doesn't always cause symptoms and may only be detected during a routine pregnancy scan. But these symptoms aren't necessarily a sign of a serious problem.
They can sometimes be caused by other problems, such as a stomach bug. Read more about the symptoms of an ectopic pregnancy. Contact your GP or call NHS if you have a combination of any of the above symptoms and you might be pregnant — even if you haven't had a positive pregnancy test.
Your GP will ask about your symptoms and you'll usually need to do a pregnancy test to determine if you could have an ectopic pregnancy. You may be referred to a specialist early pregnancy clinic for further assessment, where an ultrasound scan and blood tests may be carried out to confirm the diagnosis. These symptoms could mean that your fallopian tube has split open ruptured. This is very serious and surgery to repair the fallopian tube needs to be carried out as soon as possible.
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