I have a referral yesterday from local clinic
patient is pregnant for 10weeks, complaining of severe abdominal pain today with no per vaginal bleeding
BP lowish, patient tachycardic
scan showed intrauterine gestational sac with fetal heart activity present but want to rule out ectopic
listening to this presentation, i start to grumble, already IUGS still want to rule out ectopic?
unwilling to accept the referral, I ask her to send patient to casualty
luckily for her, me and the patient
her blood pressure still lowish on arrival
abdomen was distended and scan showed uterus looks empty but with an extrauterine gestational sac however there is still decidual sign there...
without further delay i called up my specialist telling her that there is a ruptured ectopic pregnancy for laparotomy, she came and reassess, this is a cornual pregnancy and the surrounding myometrium allow the pregnancy to progress slightly longer than usual ectopic pregnancy
we went in for laparotomy, intraop blood loss 3.2 litre, and 2 litre intraperitoneum...
I wonder, if not for the periphery doctor who insist on admission, I might kill a patient... and even if i am in her position can I make the right diagnosis?
and what if i refuse to accept the referral?
so GOD is great............. wing wink..
