A 43-year-old woman suffered from ruptured ectopic pregnancy and bleeding. She was saved by an emergency treatment team of experts

Recently, a rescue team composed of departments including gynecology, ultrasound, laboratory, and anesthesia of the Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Affiliated Hospital of Hunan Institute of Traditional Chinese Medicine) successfully treated a critically ill patient with ruptured tubal pregnancy and bleeding.

Case review

On the evening of October 8, 2024, 43-year-old Ms. Jiang suddenly had worsening pain in her lower abdomen, which was unbearable, and was accompanied by a feeling of anal swelling. A small amount of dark red blood flowed out of her vagina, and she vomited twice with stomach contents, dizziness and fatigue, but no chills or fever.

The patient was treated in another hospital, and the urine HCG test was positive. Color Doppler ultrasound showed a mixed echogenic mass on the right side of the pelvis, indicating the possibility of ectopic pregnancy. It was recommended that she be transferred to a specialist hospital for further treatment.

For further diagnosis and treatment, accompanied by her family, the patient came to the gynecology emergency department of Hunan Hospital of Integrated Traditional Chinese and Western Medicine (Affiliated Hospital of Hunan Institute of Traditional Chinese Medicine) . The emergency department intended to "examine the cause of abdominal pain: ectopic pregnancy?" and admitted her to the gynecology department.

After examining Ms. Jiang at her bedside, Dr. Cai Yu, the director of the Department of Gynecology , considered that the patient had a high possibility of ruptured ectopic pregnancy and intra-abdominal bleeding. The patient's abdominal pain gradually worsened, and according to the results of the re-examination of the color Doppler ultrasound, it was considered that the intra-abdominal bleeding had further increased.

After a quick assessment of the patient's condition, surgical treatment was inevitable. Director Cai Yu believed that the patient's condition was extremely critical and the intra-abdominal bleeding was progressively increasing, so he recommended emergency laparoscopic surgery.

During the operation, blood accumulation and blood clots in the pelvic and abdominal cavity were observed, with a volume of about 1200 ml. The right ampulla of the fallopian tube was swollen to about 1*0.5 cm in size, purple-blue in color, and active bleeding was observed at the fimbria.

The operation was successfully completed. After the unremitting efforts of the medical staff, Ms. Jiang's condition was out of danger and she was discharged smoothly on October 13. To express their gratitude, Ms. Jiang and her family sent a banner of thanks to Director Cai Yu .

1. What is ectopic pregnancy?

Director Cai Yu introduced that ectopic pregnancy, commonly known as "ectopic pregnancy", refers to the abnormal situation that the fertilized egg implants and develops outside the uterine cavity. This phenomenon is relatively common in obstetrics and gynecology, with an incidence rate of about 2% to 3%, and is one of the main causes of maternal death in early pregnancy.

2. What are the causes of ectopic pregnancy?

The main causes of ectopic pregnancy include fallopian tube inflammation, fallopian tube dysplasia or dysfunction, contraceptive failure, and the use of assisted reproductive technology.

Among them, fallopian tube inflammation is the most common cause, which may cause adhesion of the fallopian tube mucosa, narrowing of the lumen, etc., making it impossible for the fertilized egg to enter the uterus smoothly.

In addition, fallopian tube dysplasia (such as excessively long fallopian tubes, poor development of the muscle layer, lack of mucociliary cells, fallopian tube malformations, etc.) is also an important factor.

3. What are the symptoms of ectopic pregnancy?

Typical symptoms of ectopic pregnancy include amenorrhea, abdominal pain, and vaginal bleeding. After amenorrhea, most patients will have a history of amenorrhea for 6 to 8 weeks, but some patients have no obvious history of amenorrhea and mistake irregular vaginal bleeding for menstruation.

Abdominal pain is the main symptom of tubal pregnancy, accounting for about 95%, often manifested as dull pain or soreness in the lower abdomen on the affected side. Vaginal bleeding is often irregular, dark red or dark brown, with a small amount of dripping, generally not exceeding the amount of menstruation.

If the fallopian tube pregnancy is aborted or ruptured, the patient may suddenly feel tearing pain in the lower abdomen, accompanied by nausea, vomiting, and intracavitary bleeding. In mild cases, the patient may experience fainting, and in severe cases, the patient may suffer from shock.

4. How to diagnose ectopic pregnancy?

The diagnosis of ectopic pregnancy mainly depends on the patient's medical history, physical examination and auxiliary examinations. The medical history asks the patient's history of amenorrhea, vaginal bleeding, abdominal pain and contraceptive history, etc. The physical examination focuses on the patient's abdominal tenderness, rebound tenderness and cervical lifting pain.

Ultrasound examination is an important method for diagnosing ectopic pregnancy, and vaginal ultrasound examination has higher accuracy. When blood HCG>2000IU/L and no intrauterine gestational sac is found by vaginal ultrasound, ectopic pregnancy should be highly suspected.

5. How to treat ectopic pregnancy?

The treatment of ectopic pregnancy is divided into conservative treatment and surgical treatment. Conservative treatment is suitable for patients with stable conditions, no rupture of the pregnancy site, and no heartbeat of the embryo.

Surgery is the main treatment for ectopic pregnancy and is suitable for cases with unstable vital signs, fetal heart beats, active intra-abdominal bleeding, etc. Laparoscopic surgery has become the preferred surgical treatment for ectopic pregnancy due to its advantages of less trauma and faster recovery.

6. How to prevent ectopic pregnancy?

The key to preventing ectopic pregnancy is to avoid the causes that lead to ectopic pregnancy. Scientific contraception, such as condoms and other reliable contraceptive methods are recommended to reduce the number of unwanted pregnancies and artificial abortions. Pay attention to healthy sex life, avoid unclean sex life and multiple sexual partners, and reduce the occurrence of sexually transmitted diseases.

Timely treatment of gynecological diseases such as pelvic inflammatory disease may lead to adhesion of fallopian tubes, narrowing of the lumen and other lesions, increasing the risk of ectopic pregnancy. Use assisted reproductive technology with caution, and strictly follow the operating procedures and indications when using assisted reproductive technology to avoid unnecessary risks.

7. Experts’ reminder

Director Cai Yu reminded: Ectopic pregnancy is a serious gynecological acute abdomen, and its occurrence is related to multiple factors. By understanding the relevant knowledge of ectopic pregnancy and taking effective preventive measures, its incidence can be reduced and its impact on patients can be mitigated. At the same time, confirmed patients should seek medical treatment in time to avoid serious consequences.

Hunan Medical Chat Special Author: Liu Jianguo, Department of Gynecology, Hunan Hospital of Integrated Traditional Chinese and Western Medicine (Affiliated Hospital of Hunan Institute of Traditional Chinese Medicine)

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(Edited by YT)