Funke had a positive pregnancy test, a missed period, and sharp right-sided pain. Ectopic pregnancy was the immediate concern. An urgent early pregnancy scan at Mascot Healthcare confirmed the pregnancy was safely inside the uterus — and identified a corpus luteum cyst as the source of the right-sided pain.
Nurse assistant, Akoka. Presented with 5-week amenorrhoea, positive home pregnancy test, and right-sided lower abdominal pain for 2 days — described as intermittent, sharp, score 5/10. No bleeding. No shoulder tip pain. No syncope. Vital signs stable. Referred for urgent early pregnancy scan to exclude ectopic pregnancy.
Early Pregnancy Scan (Urgent)Funke had taken the pregnancy test on a Thursday morning — her period was 5 days late, her cycles were regular, and she had suspected for a week. She had been expecting joy. What she felt instead, as the second line appeared, was the right-sided pain she had been having for two days suddenly become more significant.
As a nurse assistant at a Lagos hospital, Funke had been present when two ectopic pregnancy emergencies had come through the department. She knew the triad: positive test, missed period, one-sided pain. She called Mascot Healthcare at 9 AM. She was seen by 10 AM.
"I need a scan to rule out ectopic," she told the receptionist. In the scan room, the sonographer performed the transvaginal scan. The uterine cavity came into view — and inside it, clearly visible, a small gestational sac with a yolk sac. "Your pregnancy is inside the uterus," the sonographer said, before Funke could ask. "It is not ectopic."
Ectopic pregnancy — a pregnancy implanting outside the uterus, most commonly in the fallopian tube — is the leading cause of maternal death in the first trimester. One-sided pelvic pain with a positive pregnancy test is an ectopic pregnancy until a scan confirms intrauterine pregnancy. This is a same-day scan indication.
Confirmed pregnancy by urine test — but location unknown without a scan.
Intermittent right lower abdominal pain — the site of the right fallopian tube; raises ectopic pregnancy as the primary concern.
Pain present for 2 days — in a haemodynamically stable patient, providing a narrow window for urgent assessment before potential rupture.
Absence of vaginal bleeding does not exclude ectopic pregnancy — many ectopics present without bleeding until rupture.
As a nurse assistant, Funke knew exactly what the combination of symptoms meant — and came in the same day. Her clinical knowledge may have saved her life.
Funke's fear was specific and grounded in clinical knowledge — which made it more, not less, frightening. She knew that an undiagnosed ectopic that ruptured could cause haemorrhage severe enough to kill within hours. She had mentally rehearsed the conversation she might have to have with her partner on the way to the clinic.
The fact that she had come in the same day — instead of waiting to "see if the pain passes" — was, the doctor told her, exactly the right decision. A ruptured ectopic in a patient who had delayed 24–48 hours more would have been a very different presentation.
Uterine cavity: single intrauterine gestational sac clearly identified — centrally located, round, with echogenic rim (decidual reaction). Yolk sac present: 3.2 mm (normal for 5 weeks). Embryonic pole: visible but cardiac activity not yet detectable at this gestation (expected from 5 weeks 5 days). Crown-rump length: not yet measurable.
Right adnexa: no adnexal mass; no free fluid in the right adnexa; no ring sign (which would suggest tubal ectopic). Right ovary: 3.1 × 2.4 cm — corpus luteum cyst present (1.8 cm, thick-walled, with peripheral Doppler flow — the "ring of fire" sign of a corpus luteum). This is the source of Funke's right-sided pain — a normal physiological cyst of early pregnancy.
No free fluid in the Pouch of Douglas. No haemoperitoneum. Conclusion: intrauterine pregnancy approximately 5 weeks; corpus luteum cyst — normal finding; ectopic pregnancy excluded.
Intrauterine pregnancy ~5 weeks (gestational sac + yolk sac). Right corpus luteum cyst (1.8 cm) — source of right-sided pain. Ectopic excluded. No free fluid.
Return for viability scan at 6 weeks 5 days (to confirm cardiac activity); corpus luteum cyst will resolve spontaneously; a painkiller for right-sided discomfort; return immediately if pain worsens or bleeding develops.
Viability scan at 6 weeks 5 days: FHR 122 bpm — viable intrauterine pregnancy confirmed. Corpus luteum cyst reduced to 0.9 cm. Delivered at 39 weeks — healthy baby boy.
Funke delivered a healthy baby boy at 39 weeks. The ectopic scare was resolved in a 12-minute scan. The corpus luteum cyst — the real source of her pain — resolved by 10 weeks. She has told every woman she knows: "One-sided pain with a positive test — go in the same day."
One-sided pelvic pain with a positive pregnancy test is an ectopic pregnancy until proven otherwise by scan. This is a same-day scan — not a "wait and see." The only investigation that safely excludes ectopic pregnancy is an ultrasound confirming intrauterine location.
A corpus luteum cyst — a normal physiological finding — is the most common cause of one-sided pelvic pain in early pregnancy once ectopic is excluded. It is benign, resolves spontaneously, and requires only reassurance.
Positive test + missed period + one-sided pain = come in the same day for a scan. Ectopic pregnancy cannot be excluded any other way — and it can be life-threatening if missed.
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