Ruptured heterotopic pregnancy presenting with relative bradycardia in a woman not receiving reproductive assistance.
We report a case of heterotopic pregnancy in a woman who had not undergone in vitro fertilization or any other reproductive assistance. The patient failed to mount a tachycardic response to hemorrhagic shock. Bradycardia is a well-established phenomenon in the setting of hemoperitoneum and particularly with ruptured ectopic pregnancy. This is a case of heterotopic pregnancy with relative bradycardia in a woman without predisposing factors for heterotopic pregnancy. We make suggestions on avoiding common pitfalls in the emergency department diagnosis of heterotopic pregnancy. We also address the similar clinical presentations of heterotopic pregnancy and intrauterine pregnancy with ruptured corpus luteum cyst.
Department of Emergency Medicine, University of Virginia Health System, Charlottesville, VA 22908-0699, USA. mps7a@virginia.edu
Michael P
MP
Somers
Michelle
M
Spears
Arthur S
AS
Maynard
Scott A
SA
Syverud
D000328:Adult; D001919:Bradycardia / Q000209:etiology*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006400:Hematocrit; D006801:Humans; D020896:Hypovolemia / Q000209:etiology; D010048:Ovarian Cysts / Q000175:diagnosis; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012421:Rupture / Q000150:complications / Q000000981:diagnostic imaging; D012771:Shock, Hemorrhagic / Q000209:etiology; D016216:Ultrasonography, Prenatal
D018997:Chorionic Gonadotropin, beta Subunit, Human