Wednesday, September 28, 2011

Unusual pregnancy

A mom came in after being referred from the health centre.  She had passed out while at the health centre, and they thought she had a ruptured ectopic pregnancy (where the baby forms outside the uterus, usually in the fallopian tube, where it can not survive).  A ruptured ectopic pregnancy is something we see almost everyday, so our nurses are well trained in looking for ruptured ectopics among the pts who come to the ER and in the basic stabilization of them prior to surgery.  Before I knew it, a nurse was asking me to sign a slip to get blood cross matched for the patient before I even knew what was wrong with the patient.  

After signing the paper, I found the pt already had an IV started and the ultrasound machine was there ready for me to do an exam.  The husband reported his wife had not had a period for 3 months, had fainted at the health centre and was very weak at home.  The history of no period, the fainting and the distended abdomen I was seeing on mom all made me worried for a ruptured ectopic also.  As I ultrasounded the pt, I saw a large empty uterus, an irregular mass to the R side of the uterus and a lot of blood by her liver and spleen.  Jim was walking through the ER at that time, so I asked him to come take a look and as I was showing him the fluid again, we found the baby way up by the spleen.  This wasn’t just a ruptured ectopic pregnancy, this was an abdominal pregnancy, something I had never seen before.    

An abdominal pregnancy is where the baby doesn't try and grow in the fallopian tube, but outside the fallopian tube - anywhere in the abdomen.  Most ectopic pregnancies rupture (break) between 2-3 months of life and the baby dies and the mom can also die without surgery.  Abdominal pregnancies, can go undetected for a longer period of time, especially here where most women aren't getting early prenatal care.  This pregnancy was already 18 wks (4.5 months) when she came in.  As is common with any sort of ectopic pregnancy, mom's life is threatened by all the bleeding that occurs inside of her.  With quick teamwork amongst the ER nurses, lab staff and OT staff - she was quickly taken to surgery, where Jim and Maggie were able to stop the bleeding and save mom's life.  The baby was too small and could not survive.  

Good work everyone.  I am thankful for the great team that we have here, working together to serve those who come to Nazarene Hospital.