Case report of a ruptured ectopic pregnancy A 34-year-old female presented to the Emergency Department complaining of left lower abdominal pain. It was a sharp pain and had been waxing and waning for about 21/2 weeks. She had presented to De Soya Maternity Hospital 12 days back with a similar abdominal pain and intermittent vaginal bleeding for two days. She was found to be pregnant at that visit and had a quantitative beta HCG of 352 miu/ml. She had been further evaluated with a trans-abdominal and trans-vaginal pelvic ultrasound, which had not demonstrated an intrauterine pregnancy. The patient had been referred for follow up with the gynecology consultancy. Since pain got worsened, she was again admitted to the hospital. Past medical/ …show more content…
This was supported by the dropping of hematocrit from the previous visit. Patient was taken urgently to the operating room, where she underwent laparoscopic partial salpingectomy. Recovery was uneventful and discharged with a follow up plan. Discussion The incidence of ectopic pregnancy has been increasing in the past several decades from 0.5% of pregnancies being ectopic in the 1970s to 2% in the mid-1990s [1,2]. However, with improved medical diagnostics and treatments, the death rate has fallen from 35 per 10 000 ectopic pregnancies in the 1970s to 4 deaths per 10 000 in the mid-1990s [1,3]. Ectopic pregnancy is most commonly diagnosed between 6 and 10weeks gestational age. 6 – 16% of first-trimester pregnancies presenting to the Emergency Department with complaints of pain or bleeding will be ectopic pregnancies [1]. If the patient has both these complaints, the incidence of ectopic pregnancy is approximately 39% and will increase to 54% if the patient also has a risk factor for ectopic pregnancy [2,4]. Most ectopic pregnancies implant in the fallopian tube, with 80% in the ampulla, 12% in the isthmus, 5% in the fimbria, and 2% in the interstitial region. Conditions that alter the architecture of the fallopian tube will block the usual transit of the fertilized ovum and it is the greatest risk factors for ectopic pregnancy. A history of previous tubal surgery conveys a 21-fold risk, previous ectopic pregnancy conveys a 7–13-fold risk, pelvic inflammatory disease increases risk 4-fold, and fertility assistance increases risk 3-fold. Other risk factors include smoking, Intra Uterine Contraception Device use, and advanced maternal