Case of the week 24

A 32-year-old female is brought by ambulance to the ED. She was a driver of a small hatchback car, which was hit by another car on the passenger side on Marmion ave an hour ago. She is 32 weeks pregnant. The patient is in the resuscitation cubicle, with full cardio-respiratory monitoring and spinal immobilization. The hospital trauma call has done by Triage nurses already.

Her Vitals- GCS-15, HR- 130, BP- 90/60, RR- 24, Sats- 99% (6 L/min Oxygen)

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The daily educational pearl – interesting figures about ectopic pregnancies

Ectopic pregnancies

– in the medical literature of the last 50 years there are 57 cases of ectopic pregnancy after hysterectomy – 31 early, presumed to have occurred prior to the procedure, and 27 late, that occurred years after the hysterectomy. The presumed mechanism is the presence of a vaginal fistula or of fallopian tube prolapse.

– the incidence of heterotopic pregnancy (coexistence of intrauterine + ectopic pregnancy) is 1:6,000 – 1:8,000 – increasing, more likely to occur after fertility treatment.

– the sensitivity of urine qualitative bHCG is 95 – 99% – lower in early pregnancy and with dilute urine.

So, consider ectopic pregnancy in all women of fertile age even if they had a hysterectomy. And if your clinical suspicion is fairly high, use serum bHCG to rule it out, just a negative urine pregnancy test is not enough.