Widespread literature has shown that a p H of less than 7.2 is associated with decreased contractility, low cardiac output, bradycardia, arrhythmias and decreased blood flow to the liver and kidneys. Many patients with severe haemorrhage can establish coagulopathy very quickly as our case has demonstrated.At present there is nouniversally established definition of coagulopathy though many experts use prolonged prothrombin time as an indicator of coagulopathy.
On arrival to the emergency department her Glasgow Coma Scale (GCS) was 3.
She had a pulse rate of 130 beats per minute; unrecordable blood pressure; haemoglobin of 55g/l; metabolic acidosis with a p H of 6.8; lactate 15; and a potassium of 6.6 mmol/l.
The clinical presentation of ectopic pregnancy is extremely variable ranging from asymptomatic to haemorrhagic shock.
Unforeseen tubal rupture can be a source of substantial morbidity and mortality.
Our case clearly demonstrates the detrimental multi-systemic effects and subsequent threat to life created by haemorrhage from a ruptured ectopic pregnancy.
Acute haemorrhage results in decreased cardiac output and pulse pressure that is detected by baroreceptors in the aortic arch and atrium.
A positive pregnancy test prompted notification to the gynaecology team who performed ultrasonography imaging which revealed significant haemoperitoneum.
An immediate decision was made to perform laparotomy in view of the most likely diagnosis of a ruptured ectopic pregnancy.
Cardiopulmonary resuscitation (CPR) was immediately commenced. Spontaneous circulation returned after 13 minutes of CPR at home.
She was then transferred to the emergency department.
Neural reflexes subsequently cause an increased sympathetic outflow to the heart and other vital organs resulting in vasoconstriction, and redistribution of blood flow away from non-vital organs.