[Hemorrhagic shock--an emergency in extrauterine pregnancy]

A total of 59 female patients with suspected extrauterine pregnancy were admitted to the Department of Gynecology and Obstetrics of Zabok General Hospital from January 1, 1990 to December 31, 1994. The incidence of extrauterine pregnancies is 1.3% with regard to a total number of deliveries. Dominant clinical symptoms were amenorrhea, abdominal pain and abnormal bleeding from the uterus. Seven (14%) patients developed hemorrhagic shock. Resuscitation had not postponed the surgical procedure. The average value of serum beta HCG was 1700 IU/L. Amenorrhea was from 6-12 weeks. The age of patients ranged from 20 to 40 years. Seven (14%) patients had intrauterine device. There were 14 (27%) nulliparas, 15 (29%) primiparas, 20 (39%) secundiparas and two (4%) women had three pregnancies. The evaluation included ultrasound of the abdomen in 22 (37%) patients, culdocentesis in 31 (53%) of which 4 (13%) procedures were negative punctures. Laparoscopy was performed in 15 (25%) patients and exploration of the uterus in 36 (61%). Pathohistological finding of decidua was seen in 19 (53%) patients, Arias-Stella reaction in 3 (8%) and histological finding of the endometrium in secretion was obtained in 14 (39%) patients. Laparotomy was done in 44 (75%) patients; adnexectomy in 23 (39%), salpingectomy in 30 (51%), and expression of the ovum in 3 (5%). One patient underwent laparoscopic administration of carboprost. Postoperative course was uneventful. Ectopic pregnancy is still the cause of 10% of the maternal deaths and is the leading cause of deaths in the first trimester of pregnancy of which more than 80% of deaths are due to massive hemorrhage. We have emphasized that efforts should be made to improve the diagnosis and, thus, the treatment.