CASE HISTORY
Mrs Maysa is a 32-year-old woman who presents after 6 weeks of amenorrhoea with abdominal pain and dizziness. Her observations on admission are blood pressure 90/50 mmHg, pulse 115/min, temperature 36.9°C. She has a positive urinary pregnancy test.
A What is your differential diagnosis?
EP. The findings of cardiovascular instability, in the presence of pregnancy, are an ectopic until proven otherwise.
B What are the key points in her history, examination and investigation?
An EP should be suspected in any woman of reproductive age who presents with symptoms. This patient has classical symptoms of ectopic pregnancy: pain and dizziness. She also has signs of hypovolaemic shock. She has a positive urinary pregnancy test.
C Discuss her management.
‘C ABC’. The patient should have a large bore cannula inserted and be given IV fluids. Bloods should be taken for full blood count (FBC) and ‘Group and Save’. She should remain nil by mouth. She requires an abdominopelvic examination. A senior colleague should be informed about her admission and the possibility of her requiring an urgent laparoscopy.
The patient had a laparoscopy and was discovered to have a large right ruptured EP in her Fallopian tube with 1.5 litres of blood in her pelvis. She had a salpingectomy and subsequently recovered well.
Multiple Choice Questions
Pregnant in first trimester develop vaginal bleeding and lower quadrant pain, she denied any passage of tissue. U/S shows: No sac either intrauterine or extrauterine, what is the most likely diagnosis?
- A. Ovarian ectopic
- B. Complete abortion
- C. Missed abortion
- D. Pregnancy of unknown location
Pregnant at 8 weeks with inevitable abortion, they let her decide what she want, after 15 min severe gush of blood coming out, what to do?
- A. Observe
- B. Mifepristone
- C. D&C
- D. Expectant management
Female with missed abortion, what to do?
- A. Misoprostol
- B. Hypertonic saline
- C. Myotomy
- D. Oxytocin
Pregnant at 8 weeks of gestation with vaginal spotting and everything else is normal, upon examination cervix is closed. On US normal gestational sac seen, what is the most appropriate management?
- A. Reassurance
- B. Evacuate
- C. Misoprostol
- D. Repeat US