I remember one of those dreadful nights as a medical house officer fresh from medical school. I was rotating through obstetrics and was on-call with an obstetric registrar. We had been called to see a woman with a queried appendicitis but the ER doctor called us in to rule out a possible ectopic/tubal pregnancy. Tubal pregnancies and appendicitis have one thing in common -pain in the right lower abdomen. After the registrar examined the lady, he sent her for an ultrasound scan to rule in a tubal pregnancy. Shortly afterwards, a senior registrar (who had just passed his fellowship exam of the West African College of surgeons) did the scan. We watched eagerly as he pointed at the female pelvic area landmarks, more like teaching us as we watched on with ignorance but enthusiasm. His conclusion was that ‘this is not an ectopic/tubal pregnancy’. The registrar referred the patient back to the ER doctor and ordered me to go attend to other duties. It was 1 am on a Friday night.
About 30 minutes later, the obstetric senior registrar on-call with us stormed into the ER screaming at the registrar and I to leave whatever we were doing and join him at the theater. He had seen the woman at the request of the ER doctor (who was not satisfied with the registrar’s decision) and disregarding the ultrasound scan performed a culdocentesis (a medical procedure that involves extraction of fluid from a rectouterine pouch behind the vagina through a needle) ordered the woman for surgery. When he opened up that woman, the fetus in the perforated tube was at least 5 cm long and there was blood shooting up, reaching the ceiling! It’s a picture I will never forget. She would have died if not for the intervention of the senior registrar.
Why am I telling you this story?
It is the umpteenth time I am hearing of another woman dying from ‘appendicitis’ when it was an ectopic pregnancy. For some reasons, doctors seem to rely heavily on ultrasound scans to make this diagnosis. Sadly, ultrasonography is operator dependent so if the person behind the machine isn’t skilled, the ultrasound result is worthless. Another sad thing is that these operators rather than admit to ignorance would make-up diagnosis not to lose face… too many women are dying and its time to do something about it!
Let us start with basic education.
If you are a woman that still menstruates and you develop pain in the right lower part of your abdomen, assume it is an ectopic pregnancy until proven otherwise especially if you are not on a reliable for of contraception. You should also be concerned if:
You miss your monthly period or if it is delayed.
You are spotting or bleeding from the vagina at a period when it is not your time.
You have a history of pelvic infections, sexually transmitted infections
You have a history of infertility
You have a history of ectopic pregnancy
You have a history of previous abdominal surgery, assisted reproductive surgery or appendectomy
You have a history of endometriosis
You have an IUD in place (if pregnancy occurs it may be ectopic)
See your doctor and tell him you are concerned it may be an ectopic pregnancy. Ultrasound scans are good but if you live in the developing countries you may want to get multiple opinions. Culdocentesis is an alternative to ultrasound scans if your doctor can perform one. A urine and blood pregnancy tests are also helpful.
Take charge of your health, be informed and pass on that information!
