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. Objectives. To report the diagnosis by US of a suspected case of ruptured ectopic pregnancy despite a supposedly in utero pregnancy. Case report. 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. Conclusion. Ultrasound is a helpful tool in emergency care, particularly in out-of-hospital settings. An earlier “normal” US examination cannot definitively exclude uterine rupture.

Key words :

• out-of-hospital emergency medicine
• ultrasonography
• ruptured ectopic pregnancy