Case history
Case history #1
A 23-year-old woman (nulligravida) presents with a 2-day history of sharp intermittent right lower quadrant abdominal pain, non-radiating, without any alleviating factors, exacerbated with movement, progressively worsening, and not associated with any gastrointestinal symptoms. Her last menstrual period was 7 weeks ago. She does not have any other current medical problems. Her gynaecological history is significant for a prior chlamydial infection as a teenager, but is otherwise negative.
Case history #2
A 33-year-old woman (gravida 3 para 2) presents with a 4-day history of vaginal bleeding along with lower abdominal discomfort and nausea. She states that her symptoms have worsened over the previous 24 hours. Her last menstrual period was 6 weeks ago. She is otherwise well with no other current medical, gynaecological, or social problems. Her obstetrical history includes an abortion and two uncomplicated vaginal deliveries followed by an interval tubal ligation 1 year ago.
Other presentations
There are a number of atypical presentations in cases of ruptured ectopic pregnancy. Leakage of blood from the implantation site may provide irritation to the diaphragm, leading to referred shoulder pain. Collection of blood in the posterior cul-de-sac can manifest as a continuous urge to defecate. Symptoms of shock, including lightheadedness, may indicate severe haemorrhage and tubal rupture.[Figure caption and citation for the preceding image starts]: Blood in cul-de-sacFrom the collection of Dr Sina Haeri; used with permission [Citation ends].
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