Challenges in managing ruptured ectopic pregnancy complicated by hemorrhagic shock in an Ebola treatment unit in DR...

Ectopic pregnancy (EP) is an obstetric emergency; early diagnosis is critical for maternal survival. In resource-limited settings, such as Ebola treatment units (ETU), delayed diagnosis or management of EP often leads to rupture and life-threatening hemorrhagic shock.

We report the case of a pregnant woman in her 30s who was admitted to the ETU with suspected Ebola virus disease in the Democratic Republic of Congo (DRC). Her clinical presentation included fever and abdominal pain, which began 4 days before her admission. Thirteen months earlier, she had recovered from an Ebola infection. At admission, she presented with 8 weeks of amenorrhea and discrete pelvic pain. On vaginal examination, we noted a slightly enlarged uterus and palpated a small left adnexal mass. Laboratory exams confirmed malaria and pregnancy. Her EVD test was negative. Due to the absence of an ultrasound machine in the ETU, pelvic ultrasound was impossible. Supportive treatment was initiated. Nineteen hours after admission, the patient developed an acute surgical abdomen, with progressive left-sided pelvic pain, abdominal distension, and diffuse tenderness. A ruptured ectopic pregnancy was suspected and confirmed by diagnostic abdominal puncture, which revealed hemoperitoneum. She developed hemorrhagic shock. However, the ETU lacked an operating room, surgical equipment, and anesthetic drugs. Transfer to another ETU was not feasible due to the absence of a surgical-capable facility, while transfer to a community facility required at least a second negative EVD test 48 h after the first. We used an unused building that was part of the neighboring health center to perform an explorative laparotomy, which revealed an EP in the left tube with ampullary dislocation and active bleeding. We performed a left salpingectomy and homeostatic sutures. The real-time polymerase chain reaction (RT-PCR) tests for EVD performed at 48 and 72 h were negative. She had a normal postoperative course and was discharged from ETU to the community on the 14th day after surgery.

Ruptured ectopic pregnancy (REP) remains a life-threatening obstetric emergency that may occur in ETUs, where resources and treatment conditions are limited. To protect maternal health, ETUs should ensure not only proper care for Ebola infection but also adequate capacity for the timely diagnosis and management of obstetric complications.