OB/GYN
A 24-year-old married woman presented to the clinic with severe abdominal pain followed by vaginal bleeding…
A 24-year-old married woman presented to the clinic with severe abdominal pain followed by vaginal bleeding, for the last 6 hours. Patient's LMP was 8 weeks ago. On examination; she is drowsy and has a tense abdomen. Blood pressure 90/60 mmHg Heart rate 120 /min Respiratory rate 20 /min Temperature 36.8 ° C Which of the following is the most likely diagnosis?
Explanation
Core Concept: A ruptured ectopic pregnancy is a life-threatening obstetric emergency where a fertilized ovum implanted outside the uterine cavity (most commonly in the fallopian tube) ruptures, causing massive intraperitoneal hemorrhage and hypovolemic shock.
Clinical Presentation:
- Classic triad: Amenorrhea (LMP 8 weeks ago), abdominal/pelvic pain, and vaginal bleeding.
- Signs of rupture and shock: Sudden severe pain, tense/rigid abdomen (peritonitis), hypotension, tachycardia, and drowsiness/altered mental status.
Diagnosis:
- First-line: Quantitative serum beta-hCG and Transvaginal Ultrasound (TVUS) showing an empty uterus, an adnexal mass, and free intraperitoneal fluid.
- Gold standard: Diagnostic laparoscopy (which also serves as the definitive therapeutic intervention).
Management:
- Acute: Immediate ABCs, large-bore IV access, aggressive fluid and blood product resuscitation, and emergency surgical intervention (laparoscopic or open salpingectomy/salpingostomy) to stop the bleeding.
- Long-term: Monitor serial beta-hCG levels until they reach zero. Administer RhoGAM if the mother is Rh-negative, and provide counseling regarding future fertility and the increased risk of recurrent ectopic pregnancies.