Last week I arrived at the Sexology Clinic at 7am hoping to do some reading before seeing patients. In this profession one has to keep reading or get irrelevant as new scientific advances become the norm in patient care. As the security guard opened the gate, I noted a woman prostrate with a man besides her rubbing her back at the door of the clinic. Her eyes were red, seemingly from prolonged crying.
“I am sorry doctor. Sincerely I did not mean to cause harm,” the man said as I alighted from the car and walked towards them. I nodded reassuringly, not sure what this was about. I helped lift the lady onto a stretcher and started my enquiry as she was being wheeled to the consultation room.
The lady, Janet, had excruciating pain in the lower part of her tummy. It began suddenly during sexual intercourse. Towards dawn, the pain became unbearable and Janet fainted for a few minutes. The man was in panic. He got a taxi and they drove to the Sexology Clinic at 5am.
Janet’s monthly periods had delayed for two weeks. She was not using any contraceptive. On examination I found her to be rather pale, a sign that she could have lost blood. There was pain almost everywhere in her moderately distended tummy especially on the lower left quadrant. It quickly occurred to me that I could be dealing with a case of a ruptured ectopic pregnancy.
Ectopic pregnancy is a situation where one conceives but the foetus implants and starts to grow outside the womb. The common site for this is in the fallopian tube but it could happen anywhere within the tummy, including in the intestines and ovaries. Because these organs are not meant for nurturing pregnancies, they soon get stretched and easily tear or rupture, leading to internal bleeding. This can happen very early in pregnancy. In a few circumstances the foetus can actually grow to viability.
Whatever the case, an ectopic pregnancy is a time bomb. When it ruptures, uncontrollable bleeding occurs internally and can be life threatening. To confirm my suspicion, I did a quick pregnancy test. It was positive. To be sure, I inserted a needle in Janet’s tummy to try and see if I could aspirate blood from the bloated tummy, and yes, it was there in plenty. My fears were confirmed.
As we prepared to take Janet to theatre for emergency operation, she collapsed again. Her heart rate was now racing at 120 beats per minute, a sign that she was going into shock from over bleeding internally. I ordered for blood to transfuse her as she was being wheeled to theatre.
Theatre was tense. The anesthetist was not sure that he should give a semiconscious woman medicine to induce further coma for the operation to happen. This is when the surgeon and the anesthetist go into disagreement.
“Would you rather we wait for her to bleed to death?” I asked the anesthetist. He apprehensively gave the anesthetic.
We quickly dissected layer after layer of the tummy wall, eventually reaching the sea of blood that had flooded all the abdominal organs. We sucked it out in a rush and identified the source of bleeding. It was the left fallopian tube. We removed the debris of the conception and tied off the wounded tube to stop the bleeding. “Is she breathing?” I asked the anesthetist in a panic. “We are doing well,” he answered tensely. The blood being transfused was flowing smoothly. It was a sigh of relief for everyone.
“Never ignore painful sex, it can signal a life threatening situation,” I said jokingly as we stitched back the layers of Janet’s abdomen. We burst out laughing, realising how we had all panicked. Janet recovered well from anesthesia and by the time she was being wheeled to the ward, she could talk.
“Will I have another baby, doctor?” she asked, to which I nodded vigorously. The ectopic pregnancy had damaged only one fallopian tube. The remaining one was intact and could lead to as many pregnancies as she wanted. Three days later Janet was ready to go home. She and her husband walked into the consultation room to bid me farewell. I could read guilt in the man’s face.
“Thank you and I am really sorry for all the mess that I caused everyone,” he said remorsefully. I repeated that ectopic pregnancy is nobody’s mistake. It is a common but manageable mishap.
