obstetrics and gynecology paper I
Intrauterine abortion combined with tubal pregnancy rupture
A Rare Case Report
Simultaneous termination of both intrauterine and extrauterine pregnancies is an exceedingly rare clinical phenomenon. We report a compelling case encountered during a house call.
Patient Background
The patient, a 23-year-old woman, had been married for two years without giving birth. She had regular menstrual cycles but experienced a 52-day amenorrhea accompanied by early pregnancy symptoms such as nausea, food aversions, and drowsiness. On April 22, 1979, she suddenly experienced vaginal bleeding and lower abdominal pain, followed by the expulsion of embryonic tissue. A clinical examination confirmed a complete abortion. Subsequent cessation of vaginal bleeding and alleviation of abdominal pain left her in generally good health.
Clinical Presentation and Diagnosis
Nine days post-abortion, the patient attempted sexual intercourse and immediately experienced right lower abdominal pain, dizziness, and sweating. Initially misdiagnosed at a local hospital as either post-abortion infection or intestinal parasitism, she was given tetracycline and analgesics and sent home. The following morning, she experienced severe abdominal pain and symptoms of shock. Upon emergency admission to the commune hospital, her blood pressure was recorded at 60/30 mmHg, with a pulse rate of 112/min. She displayed pale skin, excessive sweating, and agitation, with generalized abdominal tenderness—particularly in the right lower quadrant.
An emergency diagnostic paracentesis yielded non-clotting, dark-red blood, confirming a diagnosis of ruptured ectopic pregnancy.
Treatment and Outcome
Immediate fluid resuscitation and a 400 ml blood transfusion were administered, followed by surgical intervention under local anesthesia. Approximately 2000 ml of intraperitoneal blood and clots were evacuated. The ampullary region of the right fallopian tube was found to be engorged, resembling the size of a duck egg, and had ruptured. A 3 cm-long male fetus was found free-floating in the abdominal cavity. A right salpingectomy was performed, revealing internal placental tissue. The contralateral fallopian tube and ovary appeared normal, and the uterus was slightly enlarged but soft, with no adhesions. An additional 350 ml of retrieved abdominal blood was reinfused without complications. The patient recovered fully and was discharged 10 days post-operation.
Conclusion
This case underscores the critical nature of thorough evaluations in patients who present with abdominal pain post-abortion, as rare conditions like a simultaneous intrauterine abortion and ruptured ectopic pregnancy could be easily overlooked or misdiagnosed. Prompt diagnosis and surgical intervention were vital in this case, leading to a successful outcome.
This report was originally published in Nanling Medicine,1979;1:21, 05/14/1979, Nanling County Hospital, Pan Yaogui & Li Mingjie
from 宫内妊娠流产合并输卵管妊娠破裂一例报告
