Hypotension after medical termination of pregnancy: think outside of the uterus.
BACKGROUND
Under usual circumstances, an ectopic pregnancy would not be generally considered in the initial differential diagnosis of shock after voluntary termination of pregnancy.


OBJECTIVE
To present a rare case of a young woman with shock after voluntary termination of pregnancy due to undiagnosed ectopic pregnancy with concealed hemorrhage.


METHODS
A 37-year-old woman presented to the Emergency Department (ED) 3 days after termination of pregnancy with clinical features of shock. The patient had some evidence of infection and was initially managed as a case of septic shock secondary to possible complication of recent termination of pregnancy. Subsequent work-up led to suspicion of internal bleeding, and ruptured ectopic pregnancy was confirmed and managed successfully.


CONCLUSIONS
Ruptured ectopic pregnancy can present with a wide range of symptoms and under variable circumstances. Recognition of subtle signs of hemorrhage and consideration of the diagnosis of ruptured pregnancy in the ED will lead to early diagnosis and appropriate management.
Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan, USA.
Sanobar
S
Butt
Ghulam
G
Saydain
D000028:Abortion, Induced; D000328:Adult; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000503:physiopathology; D012422:Rupture, Spontaneous / Q000150:complications / Q000175:diagnosis; D012769:Shock / Q000209:etiology*; D014591:Uterine Diseases / Q000150:complications* / Q000175:diagnosis