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Septic abortion with shock — RCPSC EM MCQ

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HardOB/GYN emergenciesSeptic abortion with shockRCPSC EM

A 26-year-old with a positive pregnancy test has sudden unilateral pelvic pain, shoulder-tip pain and syncope. BP is 82/46 mmHg, FAST shows free intraperitoneal fluid and no intrauterine pregnancy is seen. What is the next step?

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Correct answer: C — Resuscitate and obtain operative gynaecology care

The best answer is “Resuscitate and obtain operative gynaecology care”. Haemodynamic instability and free fluid in early pregnancy are a ruptured ectopic pregnancy until proved otherwise. Begin resuscitation, activate urgent gynaecology and proceed to definitive operative management. Methotrexate and serial testing are for selected stable patients, not shock with suspected intraperitoneal haemorrhage.

Reference: Emergency Care BC: First-trimester bleeding—Ectopic pregnancy diagnosis: https://emergencycarebc.ca/clinical_resource/clinical-summary/1st-trimester-bleeding-ectopic-pregnancy-diagnosis-2/