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)
- What are the key features of your initial assessment?
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The following x-rays are from a 30 year old with sudden onset of severe abdominal pain. What two abnormalities can be observed? One is acute and the other, an incidental pathology. Continue reading →
The following lumbar spine AP x-ray is from a 55 year old woman with low back pain. What can be seen? Continue reading →
The following ultrasound images are from a 38 year old, with a h/o 8 weeks LMP, who presented with PV bleed. What radiological sign can you see in the images? Continue reading →
The following CT images are from a 30 year old female patient who has presented with right iliac fossa pain. What can you see? Continue reading →
– 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.