33years multipara patient started to complain of abdominal pain with vomiting and diarrhea5days post normal
menstrual cycle she receive medical management as a case of food poisoning,but abdominal pain was continue and
increased gradually specially with menstrual cycle,and she use analgesic2to3times per week,so pain relived
temporary then next menstrual cycle was described as hypo-menorrhea then dyspareunia started to developed and
increase gradually no any associated symptoms related to early pregnancy,by the end of the month pain was aggravated
and not response to analgesics third cycle was also hypo-menorrhea later on she admitted to emergency unit as a case of
acute abdomen with second degree shock,then by ultrasound diagnosed as9weeks ectopic pregnancy.
Discussion:
Medical disease can masking symptoms of early pregnancy.
Avoid recurrent use of analgesic.
Dyspareunia is important symptoms in ectopic pregnancy with absence of pelvic inflammatory disease.
hypo-menorrhea should be managed as early pregnancy symptoms especially in two consecutive cycles
Conclusions:
*Hypo-menorrhea with negative pregnancy test not exclude presence of pregnancy,so incidence of hypo-menorrhea
with pregnancy need to be assessed.
*Incidence of dyspareunia related to ectopic pregnancy need for evaluation in women experienced intercourse before
last missed cycle
                                                                                                                                                                                                                                                      A case reported by\Dr.SomayaAl-shawafee