The facts behind this life-threatening condition.
By Marven Ewen, MD
It was another busy night in the ER. The patient was a 32-year-old woman who was brought to the emergency room complaining of severe abdominal pain and vaginal bleeding.
Her blood pressure was still normal but she was tachycardic and appeared pale. Her last menstrual period was 8 weeks prior. She had a past history of pelvic inflammatory disease. The symptoms were suggestive of ectopic pregnancy, a potentially life-threatening condition that requires urgent medical intervention.
Ectopic pregnancy is a condition in which a fertilized egg implants outside the uterus, usually in one of the fallopian tubes but can be elsewhere in the pelvic cavity. The fallopian tube is not designed to accommodate the growing embryo.
As the embryo grows, it requires a blood supply to provide oxygen and nutrients. Eventually, it outgrows its blood supply. The surrounding tissues may become compressed and ischemic. This ischemia can lead to tissue damage and necrosis, which is the death of cells and tissues.
This area of necrotic tissue is known as an infarct - infarction of the fallopian tube can be dangerous and life-threatening, as it can cause rupture and hemorrhage, leading to shock and even death.
The infarction process of ectopic pregnancy highlights the importance of early detection and intervention to prevent serious complications. If diagnosed early, ectopic pregnancy can be treated with medication or surgical intervention to remove the affected tissue and prevent further damage.
The risk factors for ectopic pregnancy include a history of pelvic inflammatory disease, previous ectopic pregnancy, tubal surgery, and infertility treatments. Smoking, advanced maternal age, and the use of intrauterine devices (IUDs) also increase the risk.
In the emergency room, we quickly treated for shock with IV fluids and oxygen. I ordered a series of diagnostic tests, including blood tests, ultrasound, and a pelvic exam. The ultrasound revealed a mass in the patient’s left fallopian tube with blood in the abdomen, and her blood test showed a low level of beta-hCG, a hormone produced by the placenta.
I explained to the patient the gravity of her condition and the need for emergency surgery to remove the affected fallopian tube. She was understandably anxious but agreed to the procedure. We prepared her for surgery and administered pain relief medication to keep her comfortable.
During the surgery, the diagnosis of ectopic pregnancy was confirmed, and the affected fallopian tube was removed. Upon discharge from the hospital, she was advised to avoid getting pregnant for a few months and to seek medical attention promptly if she experienced any symptoms of another ectopic pregnancy.
In conclusion, ectopic pregnancy is a serious medical condition that requires urgent intervention. In EMS, it is our duty to recognize and treat this condition promptly to prevent life-threatening complications.
Treatment options for ectopic pregnancy include surgery, medication, or a combination of both, depending on the severity of the condition and the patient's overall health. Early diagnosis and appropriate management are critical to ensuring the best possible outcome for the patient.
Sources & More Information
Barnhart KT. Clinical diagnosis and management of ectopic pregnancy. Obstetrics and Gynecology. 2018;131(3), 481-489. https://www.ncbi.nlm.nih.gov/
Condou, G, Timmerman D, Bourne T, et al. The role of ultrasound in the diagnosis and management of ectopic pregnancy.
Gynecologic and Obstetric Investigation, 76(4), 249-257. https://www.ncbi.nlm.nih.gov/
Kirk E, Bottomley C, Bourne T, et al. The potential of first-trimester ultrasound to diagnose and manage ectopic pregnancy. Ultrasound in Obstetrics & Gynecology, 2011;38(3), 367-370. https://www.ncbi.nlm.nih.gov/
Lozeau A, Potter B. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2005;72(9): 1707-1714 https://www.aafp.org/pubs/afp/
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