Case No

Ectopic Pregnancy
Identity

Name : Mrs N
Age : 27 years old
Occupation : Private Employee
MR : 10 00 336
Admission Date : 03th July 2015
Anamnese

A 27 years old patient was admitted to the

Emergency Delivery Room of Dr. M. Djamil
Central General Hospital, 03/7/15 at 10.30
pm referred from private hospital with
diagnose acute abdomen ec suspect
ectopic pregnancy + anemia gravis (Hb= 3
gr/dl).
 Present Illness History
Previously the patient complains of abdominal pain and she went to
private hospital and diagnosed as ectopic pregnancy. Then she was
refered to M jamil general central hospital with IVFD and urin
catheter.
Feeling of pain in whole part of abdomen since 1 hours ago, the
pain was continue and increased by movement.
Blood from vagina (-),
History of leukorea (+) since 1 years ago, bad odor (+), not get
treatment
History of fever (-), trauma (-).
 Amenorrhea since 2 months ago
First date of last menstrual period was forgotten
This is the 3rd pregnancy
No complaint in urinary and bowel system
Menstrual History : menarche at 13 years old, irregular
cycle, once a month which last for about 5-7 days
each cycle with the amount of 2-3 times pad
change/day without menstrual pain
Previous Illness History:
There was no previous history of heart, lung, liver,
kidney disease, DM , hypertension or allergy.
Family Illness History:
There was no history of any hereditary or
contagious disease, or phsycological illness run in
the family.
 Occupation, Socioeconomics, Psychiatry, and Habitual History:
Marital history: once in 2008
History of pregnancy :
1. 2009, male, 3600gr, term pregnancy, spontaneous delivery, midwife,
alive.
2. Present pregnancy
History of family planning : The Contraceptive Injection Depo-
Provera
History of education : Senior High School Graduate
History of Occupation : Private Employee
Habitual history : Smoke (-), Alcohol (-), Drugs (-)
Physical Examination :

GA Cons BP HR RR T
Mdt CMC 100/70 90x 24 37

BW : 50 kg
BH : 150 cm
BMI : 22,2 kg/m2 normal weight

Eyes : Conjunctiva was anemic, Sclera wasnt icteric

Neck : JVP 5-2 cmH2O, no enlargement of tyroid gland
Thorax : H/L within normal limit
Abdoment : OR
Genitalia : OR
Extremity : Edema -/-, Physiological Reflex +/+, Pathological Reflex -/-
 Obstetrics record

Abdomen:
I : seems little enlarge
Pa : Abdominal tenderness (+), rebound tenderness (+),
Defense Muscular (+)
Uterine fundal was difficult to examine
Pe : difficult to examine
Au : difficult to examine
 Genitalia
Insp : v/u within normal limit, vaginal bleeding (-)
Inspeculo :
Vagina : Tumor (-), Laceration (-), Fluxus (-),
Portio : MP, size equal to an adult foot toe, tumor(-), laceration
(-), Fluxus (-)

Bimanual Internal Examination

Vagina : tumor (-)
Portio : MP, size equal to an adult thumb,
cervical motion pain(+), EUO was closed
CUT : difficult to examine
AP : difficult to examine
CD : protruded
Laboratory Findings

Parameter Result Normal Limit Unit

Haemoglobin 7,1 11,6 - 13,9 g/dL
Hematocrit 21 31 41 %
Leucocyte 15.300 5,7 - 13,6. 103 /mm3
Thrombocyte 176.000 174 - 391. 103 /mm3

Plano Test : (+)

Diagnosis :
Acute abdomen due to ruptured Ectopic Pregnancy in G2P1A0L1 7-
8 weeks of Pregnancy + Moderate anemia (hb:7,1 gr/dl)

Management :
Control GA, VS, fluid balance
Antibiotic Skin test
Crossmatching, Prepare blood transfusion (PRC 2 units)
Informed consent
Consult to anesthesiologist
Report to operation room

Plan :
Emergency Laparotomy
July 03th,2015 at 11.00 pm

Laparotomy was performed.

After the peritoneum was open, there was blood and blood clot 2000 cc
in the abdominal cavity, dark red in color
Exploration was performed, the source of the bleeding was ruptured on
pars ampularis of left fallopian tube. Uterus and Both ovaries were within
normal limits.
Impression : ruptured on pars ampularis left fallopian tube.

Plan:
Left Salphingectomy Left salphingectomy was performed.

Diagnosis:
Post Left Salphingectomy on indication of Ruptured of the left fallopian
tubes pars ampularis
Management:
Post Surgery monitoring
THANK YOU