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Cervical shock: a complication of incomplete abortion
Julian David Birch1, Divyansh Gulati1, Sachin Mandalia1
1Emergency Department, John Radcliffe Hospital, Oxford, Oxfordshire, UK.
BMJ Case Reports
|July 16, 2017
Summary
A pregnant patient in shock due to miscarriage complications rapidly improved after an emergency Evacuation of Retained Products of Conception. This case highlights critical management in urgent care settings.
Area of Science:
- Emergency Medicine
- Obstetrics & Gynaecology
Background:
- A 37-year-old primagravida presented to the emergency department (ED) in hypotensive shock.
- She was 10 weeks pregnant with a confirmed inevitable miscarriage 3 weeks prior.
Observation:
- The patient exhibited severe hypotension (90/60 mmHg), bradycardia (45 bpm), and signs of peripheral shutdown.
- Despite fluid resuscitation, her condition deteriorated, prompting activation of the major haemorrhage protocol.
- Examination revealed vaginal bleeding and a protruding sac.
Findings:
- An urgent Evacuation of Retained Products of Conception (ERPC) was performed in the ED.
- The procedure resulted in immediate hemodynamic stabilization, with blood pressure and heart rate normalizing within minutes.
Implications:
- This case underscores the importance of prompt gynaecological intervention in the ED for managing obstetric emergencies.
- It highlights the potential for rapid improvement with timely ERPC in cases of miscarriage-related shock.
- Provides valuable learning points for emergency and urgent care physicians managing similar presentations.
