We share a case of in which a pregnant lady collapsed, resuscitated and revived with surgical intervention.
A 31 years old Chinese lady with Gravida 1 Para 0 at 8 weeks of pregnancy based on last menses was referred to our centre from private hospital with the chief complaint of abdominal pain and giddiness. Patient collapsed at the private hospital and CPR commenced for 20 minutes after which she regained return of spontaneous circulation. The full blood count (fbc) there showed a hemoglobin level of 7.4 and the urine pregnancy test was positive. No ultrasound was done. Patient was sent to our centre intubated after that with the diagnosis of ruptured ectopic pregnancy. Upon arrival, patient was intubated and sedated. The blood pressure was 80/54, and the heart rate was 120. Patient was pale and had poor pulse volume with cold peripheries. Ultrasound at the emergency department showed intrauterine growth sac. Free fluid was noted over the right Morrison pouch and at the Pouch of Douglas. Repeated fbc showed hemoglobin at 6.3. The arterial blood gas showed severe metabolic acidosis with pH 6.9 and Hco3 4.3. Patient was transfused with safe O blood. The obstetrics and gynaecology team was referred promptly and patient was pushed straight to the operation theatre. Intraoperatively patient had heterotrophic pregnancy (right ruptured tubal pregnancy + missed miscarriage intrauterine pregnancy). Tubal repair and dilation and curettage were performed. Post surgery, patient was placed in the intensive care unit (ICU). Patient recovered and discharged to normal ward after 4 days in the ICU. After another 3 days in normal ward, patient was discharged.
DISCUSSION & CONCLUSION
Heterotropic pregnancy should be considered in patients with anaemic hemoglobin drop despite ultrasound finding of intrauterine growth sac. This is a rare condition and fast surgical intervention can save patient’s life.