Sudden death due to rupture of ectopic pregnancy concurrent with therapeutic abortion

We report three cases of sudden death resulting from internal hemorrhage associated with the rupture of an ectopic pregnancy. In each case, the woman had undergone therapeutic abortion before death. The ectopic pregnancies, however, were not suspected or identified before the women left the treatment facility. Subsequently, all three women suffered fatal rupture of a tubal pregnancy and associated massive intraperitoneal hemorrhage during the postabortive period (range, 14 to 32 days). Our investigation of these cases has identified the lack of standardized procedures for the adequate monitoring of tissue recovered during therapeutic abortion. Such monitoring could have resulted in identification of the ectopic pregnancy and possibly led to successful intervention. We discuss the causes and risks of failure to diagnose ectopic pregnancy during the postabortive period.