CASE PRESNTATION

I present r O.A. a 27year old applicant with secondary education, P0+2 who lives at
# 31 rumudede street rumigbo Port Harcourt.
She is a Christian of the Pentecostal denomination, Ikwere by tribe.
Her last menstrual period was 14th Aug. 2006; her gestational age at presentation
was 12wks.
She presented at the Accident and emergency with:
A 4 day history of bleeding per vagunam
And 2 day history of abdominal pain.

She was apparently well until 4 days prior to presentation when she started spotting
per vaginam. This progressed to frank bleeding.
The bleeding was severe on the 2nd day with passage of thick blood clots but
however this gradually reduced to only spotting on the 3rd and 4th day

Abdominal pains started 2 days prior to presentation, localized at the left iliac fossa,
intermittent and sharp in nature. It does not radiate to any part of the body. It’s
relieved temporarily on squatting but aggravated by lifting heavy objects. There was
no previous trauma vomiting nausea. Her bowel habits had remained unchanged.
There were associated headache and dizziness.

She attained menarche at 14 years of age.

She has a 4 –5 day menstrual flow in a 30 day regular cycle
She had an induced abortion in1991 at a gestational age of 10wks in a private clinic.
There were no postabortal complications. She also had a miscarriage in 2005. No
postabortal complications.

Her past medical and surgical history was not contributory.

Her drug history was not contributory.

She was the only wife of an Engr. Her father is a known hypertensive.
There is no family history o diabetic mellitus, tuberculosis sickle cell disease nor
Asthma.
She does not take Alcoholic beverages nor takes tobacco products in any form.
The review of her other systems was not contributory

On examination
She was a healthy looking young lady. She was not pale anicteric acyanosed
afebrile no dehydrated with no pedal edema.
Chest was clinically clear
Cardiovascularly her pulse rate was 68 beats / min
Her blood pressure was 100/60 mmHg
Her abdomen was flat and moved with respiration.
There was tenderness at the left iliac fossa.
There was no rebound tenderness.
Her liver and spleen were not palpable. Her kidneys were not balotable.

Pelvic examination: her vulva was stained with frank blood.

Her cervix was normal, the cervical os was closed.
There was tenderness at the left adnex.
Cervical excitation tenderness was equivocal.
The pouch of Douglas was empty.

An impression of threatened abortion was initially made to rule out an unruptured

ectopic pregnancy.
The patient was admitted in the gynaecological ward.
The following investigation ere ordered an the results were as follows:
1. Urgent pack cell volume - 29%.
2. Urinalysis and Urine culture did not show any abnormality.
3. A positive pregnancy test
4. Sonographic report showed:
 Bulky anteverted and empty uterus
 Left adnexal gestational sac
 Fetal pole with no cardiac pulsation.
 No free peritoneal fluid

A diagnosis of an unruptured ectopic gestation was made.

24hrs after admission, she had an emergency exploratory laparotomy and total
left salpingectomy for an unruptured left interstitial ectopic gestation.
 Findings at surgery include:
1. An unruptured left interstitial ectopic gestation
2. Normal right tube and Ovary
3. There was no heamoperiteonum.

Her recovery from anaesthesia was uncomplicated. Her vital signs remained stable
2hrs after operation.
She was transferred back to the gynaecological ward.

Post operatively; she was placed on intravenous infusion 5% dextrose saline 1 L

8hrly. She had a total of 6L.
She received parenteral antibiotics in form of Ampiclox 1g 6hrly and
Methronidaxole 500mg 8hrly both for 48hrs and intravenous Genticin 80mg 6hrly
for 5 days. The Ampiclox and Methronidaxole were converted to oral forms on
resumption of her bowel sounds on 2nd postoperation day.
She received analgesia in form of intramuscular Pentazocine 30mg 4 – 6 hrly for
48hrs.
The Foley’s urethral catheter was removed 24hrs after the operation. Her pack cell
volume on 2nd post operation was 32%.

She made remarkable progress in her clinical state.

The skin sutures were removed on the 7th post operation day.
She was counseled on the need for contraception and the nature of
the surgery she had.
She was discharged from the hospital on the 8th post operation day.
She was given a 2 week appointment to the gynaecological clinic but she was lost in
follow up.

In summary
I have presented Mrs. O.A. a 27year old applicant P0+2 who had an emergency
exploratory laparotomy and left total sdalphingectomy for an unruptured interstitial
ectopic pregnancy. She made full recovery and was discharged home on the 8th post
operative day.