Ectopic Emergency Pregnancy

When a fertilized egg implants itself outside the uterus

By Dr Mitch Shulman

Jessica*, a 23-year-old woman, was brought to the emergency room by Urgences-santé technicians. Jessica had just entered triage when she was rushed to one of the resuscitation beds because she was in such severe pain, her blood pressure was dangerously low and her heart was racing.

While waiting in line at the bank she had suddenly developed severe pain on the right side of her lower abdomen. The pain was so severe that she had fainted. The bank manager immediately called 911, and by the time the First Responders had arrived, Jessica was awake but pale and still in a lot of pain. This had never happened to her before; in fact, Jessica’s health was normally excellent, she wasn’t taking any medication and she had no known medical issues.

Many conditions can present in this way. Some can happen to anyone, such as appendicitis, and some only in women, like a ruptured ectopic pregnancy. Many are true emergencies.

And so the emergency room team quickly swung into action. While bloods were drawn for tests to help make the right diagnosis and an intravenous line was started, I quizzed and examined Jessica. She had little nausea and her appetite was recently excellent meaning stomach or intestinal problems like an appendicitis were less likely; she had no pain when urinating and there was no blood in her urine, making a kidney infection or stone less likely.

However, Jessica’s period—usually regular as clockwork—was late and she had just developed mild vaginal bleeding. All this pointed to a ruptured ectopic pregnancy as a possibility. A true emergency!

Normally, as the egg matures and is then released from the ovary, it finds its way into the Fallopian tube that leads to the uterus where implantation of the fertilized egg should happen. For a number of reasons (see the list to the left) but most often because of past ectopic pregnancies or infection involving the woman’s reproductive system, the egg’s transit is slowed so that it implants within the Fallopian tube, which isn’t built to support pregnancy.

The tube’s walls might rupture. Blood pouring into the belly can rapidly lead to a serious situation. Luckily, severe belly pain usually triggers a visit to the doctor before severe bleeding happens. But when the two coincide, the result can be life threatening. In this case, Jessica’s youth and good health gave her the advantage she needed. The usual way to make a bedside diagnosis is by ultrasound. Jessica’s urine pregnancy test was positive but by using ultrasound we could not find an embryo inside her uterus, making an ectopic pregnancy likely.

The gynaecologists were paged to the emergency room. While blood was being transfused to replace what was being lost in her belly, they prepared for an emergency operation to remove the ectopic pregnancy, stop the bleeding and repair Jessica’s Fallopian tube. She came out with flying colours, but it had been close.

* (fictitious name)

 

Risk Factors For An Ectopic Pregnancy

  • Previous ectopic pregnancy
  • Previous Fallopian tube surgery
  • Tubal ligation
  • Disease affecting the Fallopian tubes (e.g. infection with gonorrhea, chlamydia)
  • Current IUD use
  • Infertility

Health Expert
Dr. Mitch Shulman is attending physician in the emergency department of the MUHC, assistant professor in the Department of Surgery at McGill Medical School and medical consultant for Astral media.

Summer 2013, Vol 5 N°3

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