Complications of a Ruptured Ectopic Pregnancy

​BY GREGORY TAYLOR, DO, & JACKLYN MCPARLANE​, DOA 31-year-old woman with a significant medical history for one ectopic pregnancy and five spontaneous abortions presented with abdominal pain and vaginal bleeding. Her symptoms started abruptly two days earlier, and the pain was located in the right lower quadrant, which had become diffuse and she described as sharp. She was also experiencing nausea, vomiting, and vaginal bleeding.She stated she had been spotting for five days and soaking up to four pads a day. Her last menstrual period was two months before, and a home pregnancy test was positive. Her presentation was complicated by no obstetrics/gynecology follow-up, no prenatal care, and no prior ultrasound.The patient was afebrile. Her blood pressure was 89/70 mm Hg, her heart rate was 116 bpm, and her respiratory rate was 22 bpm. She was in distress, lying flat, not wanting to move, diaphoretic, and crying in pain. An abdominal exam revealed a moderately distended abdomen, diffuse tenderness with associated rebound, guarding, and percussive tenderness. A FAST exam revealed free fluid in the right upper quadrant, left upper quadrant, and posterior cul-de-sac. The history and physical exam was consistent with likely hemorrhagic shock secondary to a ruptured ectopic pregnancy.The patient was typed and screened, and fluid resuscitation was initiated. Obstetrics and gynecology was emergently consulted. A repeat blood pressure after two liters of normal saline and one uni...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research