ULTRASOUND CHRONICLES: RUPTURED ECTOPIC PREGNANCY

By: Lori Stolz, MD, GEC Ultrasound Director & Alexa Sabedra, MD, GEC Volunteer
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On our first day in Masaka, while sitting in on the chest pain lecture being given to the ECP 1s, Deus (an ECP 2 who was working in the ED at the time) quietly walked in and asked if Dr. Lori could bring the ultrasound to the ED.  On the way there he explained that a young woman in her early 20s had presented to the ED complaining of bloody stools and had low blood pressure. She had been seen by one of the intern physicians who was also working that day. The doctor thought that she had bleeding inside her intestines and was planning to admit her to the ward.  Deus heard about the patient and had noted that she had a positive pregnancy test. Knowing this information, he was concerned that something more was going on.

On arrival at the bedside the team found an unwell appearing young woman. She was pale, another ECP was repeating a blood pressure and having trouble getting a reading.  Deus wanted to perform an ultrasound exam to look for internal bleeding, a FAST exam. In a pregnant patient who is having abdominal pain or vaginal bleeding, a ruptured ectopic pregnancy could be the cause.  An ectopic pregnancy is when a pregnancy implants outside of the uterus, usually in the tubes. This is a life-threatening condition which is the leading cause of death in women in the first trimester worldwide.

Deus started the exam with a view in the right upper quadrant of the abdomen that looks at the liver and kidney. Almost immediately, he spotted the black stripe between those 2 organs and correctly interpreted this as free fluid (Blood!).  Already the team could tell that Deus had been right; that this was more than what it seemed. He next moved the ultrasound probe to her lower abdomen to look in the pelvis.  He was able to see the woman’s uterus which was empty. This is not the expected finding if it was a normal pregnancy. He moved the probe a little to the left and was able to see a gestational sac (the pregnancy)…but the sac was outside the uterus!!  There was more of the black free fluid in the pelvis as well. Now there was no question. This woman did indeed have a ruptured ectopic pregnancy that was the actual source of her bleeding and low blood pressure. This woman did not need to be admitted to the ward, and in fact would have likely died there had Deus not intervened.  The woman needed to go to the operating room right away. Deus knew this and called the surgeon who did just that.
We later learned that in the OR the surgeon confirmed the left sided ectopic pregnancy and bleeding.  They were able to remove the ectopic pregnancy and stop the bleeding. The woman lived and the next day was doing very well.  A life was saved thanks to the quick thinking of the ECP and his skillful application of ultrasound to confirm the diagnosis he suspected.
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I think this case is very special.  As someone new to volunteering with GEC it really highlighted what an incredible resource the ECPs are for Uganda.  It is amazing how much they have learned from their training and how well they apply it to patient care to save lives!  In this case, the ECP was better able to evaluate the patient than even the physician. What is troubling is that the ultrasound machine that was here at Masaka is currently broken.  The cost of fixing it is nearly that of a new machine. When Dr. Lori and I came, we were lucky to have the generous support of organizations back home that allowed us to borrow a few machines to teach the ECPs while we are here, but they are sadly coming back to the U.S. with us.  While we are here, we have been working on ways to obtain a new ultrasound machine for the ECPs. Please help us reach that goal with a donation. ​

Ultrasound Machine Fundraiser for GEC
Thanks to a very generous gift from the Ellis family in honor of their parents, Dan and Barbara Ellis, we will be offering a 100% match on all ultrasound donations up to $10,000. Our goal in the next month is to raise $30,000 to fix one of our current ultrasound machines and to purchase two new ultrasound machines.