Ruptured tubal ectopic pregnancy with negative serum beta hCG--a case for ongoing vigilance?

A 25-year-old female with a history of recent miscarriage presents with haemodynamic shock and a negative serum beta hCG. She presents to six different healthcare facilities within a single metropolitan area, during which a pelvic ultrasound scan showed an empty uterus with a subnormal rise in serum beta hCG. Suspected ruptured tubal ectopic pregnancy was confirmed following laparoscopy and salpingectomy, with histopathological confirmation of chorionic villi in the extirpated fallopian tube. This case report highlights the ongoing clinical diagnostic challenges that are associated with ectopic pregnancy; illustrates the importance of teamwork; and perhaps also draws attention to the need for a robust protocol to facilitate consistent, good-quality early pregnancy care for all women.