Case presentation

A 31-year-old primagravida female presented to the OBGYN clinic for confirmation of pregnancy after spotting over the course of the preceding week. She did not utilize assistive reproductive technology in becoming pregnant and had no history of gynecologic surgery. She has a history of irregular periods, but by her last menstrual period, she is estimated to be eight weeks gestation. At her confirmation of pregnancy appointment, the ultrasound technician estimated the gestational age to be five weeks and six days (Figures 1-3).

Figure 1: Obstetric ultrasoundObstetric ultrasound with a red arrow demonstrating a gestational age of five weeks and six days.

Figure 2: Obstetric ultrasoundObstetric ultrasound with a red arrow showing a gestation near the lateral edge of the uterus.

Figure 3: 3D obstetric ultrasound3D obstetric ultrasound with a red arrow, highlighting the location of the gestation at the angle of the uterus.

The physician was called in to review the imaging. The physician consulted other obstetricians and a radiologist and suspected a myometrial or cornual pregnancy. Due to the high risk and uncertainty about the true etiology of the pregnancy, the patient was referred to a specialty resident ultrasound clinic at a major academic institution that was holding appointments that morning. Upon follow-up with the patient, it was determined that the patient had an angular pregnancy. This diagnosis was made via ultrasound based on the location of the gestation at the angle of the uterus and medial to the uterotubular junction.

The patient was counseled to continue the pregnancy under supervision from the obstetric team. In the 48 hours following her confirmation of the pregnancy appointment, the patient began to spot and pass the pregnancy. The follow-up appointment at one week from her initial encounter demonstrated complete passage of the pregnancy on ultrasound.