title: Out-of-hospital diagnosis of a ruptured ectopic pregnancy: myometrial embryo implantation, an exceptional diagnosis.
abstract: BACKGROUND
  Ultrasonography (US) could be used in emergency out-of-hospital settings to diagnose abdominal hemorrhage.
  
  
  OBJECTIVE
  To report the diagnosis by US of a suspected case of ruptured ectopic pregnancy despite a supposedly in utero pregnancy.
  
  
  METHODS
  A mobile intensive care unit with an emergency physician on board was sent out to a 22-year-old woman suffering from acute abdominal pain. On the previous day, an 11-week pregnancy had been diagnosed and the pelvic US images were reported to be "normal." Physical examination revealed that the patient was in shock. Point-of-care US detected an intraperitoneal effusion and suspected uterine rupture. Emergency laparotomy revealed an 11- or 12-week intra-abdominal pregnancy with uterine rupture due to myometrial implantation of the embryo.
  
  
  CONCLUSIONS
  Ultrasound is a helpful tool in emergency care, particularly in out-of-hospital settings. An earlier "normal" US examination cannot definitively exclude uterine rupture.
authors.affiliation: Hôpital Avicenne, Bobigny, France. m.galinski@trs.aphp.fr
authors.forename: Michel
authors.initials: M
authors.lastname: Galinski
authors.forename: Tomislav
authors.initials: T
authors.lastname: Petrovic
authors.forename: Anabela
authors.initials: A
authors.lastname: Rodrigues
authors.forename: Monika
authors.initials: M
authors.lastname: Hermann
authors.forename: Jean
authors.initials: J
authors.lastname: Catineau
authors.forename: Frederic
authors.initials: F
authors.lastname: Adnet
authors.forename: Frederic
authors.initials: F
authors.lastname: Lapostolle
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D009215:Myometrium / Q000000981:diagnostic imaging / Q000502:physiology*; D011247:Pregnancy; D011248:Pregnancy Complications; D011271:Pregnancy, Ectopic / Q000175:diagnosis*; D012421:Rupture / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014481:United States; D055815:Young Adult