Ruptured Ectopic Pregnancy & 2.5 gm% Hemoglobin Followed by Consumption of over the Counter Abortifacient Medication

A 25 year old female patient presented at our Emergency Department with severe respiratory distress and critical condition with a haemoglobin count of 2.5 gm%. She was referred to our hospital once her condition had become unmanageable at the other hospital she had visited earlier. As she was having severe respiratory distress, the ED team had to put her on moist oxygen inhalation. The patient was conscious. however very restless with vitals showing tachycardia (an abnormally rapid heart rate) pulse rate of greater than 150 beats / minute, blood pressure Of 100/60 (maintaining With IVF) and tachypnea (abnormally rapid breathing) respiratory rate greater than 35 per minute. We also noticed anasarca (swelling throughout the body) and paleness of the skin. Physical examination of the abdomen showed tenderness and ABG (Arterial Blood Gas test) analysis showed severe metabolic acidosis. The patient was going into hypovolemic shock (an emergency condition in which severe blood or other fluid loss from the body makes the heart unable to pump enough blood) for which she was resuscitated urgently. An advice of urgent ultrasonography of abdomen was given.

Meanwhile, history from her husband revealed that the patient had consumed over the counter abortifacient medication (which causes abortion) as she had amenorrhea for one and a half months and her urine pregnancy test was positive at home one week back following that. The bleeding from vagina had lasted for three days with average to heavy now with clots. Since past three days there was no bleeding, however the patient's condition deteriorated with much weakness for which she had to seek medical help and hospitalization.

The urgent ultrasonography done in our hospital revealed a ruptured ectopic pregnancy with haemoperitoneum (a type of internal bleeding in which blood gathers in the peritoneal cavity). She needed an immediate life saving surgery and was shifted to the OT after informed consent from her husband. She was on blood transfusion as her haemoglobin was excessively low. The surgery was performed under general anaesthesia. Pfannenstiel incision was made to see the haemoperitoneum. Right corpus luteal cyst haemorrhage was excised and haemostatic suture was given. Right cornual ectopic pregnancy involving right cornua (cavity of the uterus) and right fallopian tube was seen. Right salpingectomy with rupture ectopic was performed. Peritoneal toileting was done with warm saline water, after which the abdominal wall was closed in layers. No further active bleeding was noticed.

Post operatively, she was ventilated and shifted to the ITU for critical care management. She was transfused with five units of PRBCs (Packed Red Blood Cell), four unit of FFP (Fresh Frozen Plasma) and four units of RDP (Random Donor Platelets) as her haemoglobin was only 3.8 gm/dl. She was extu bated after one day and shifted to the ward for observation and care. She was further transfused with 1 gm of iron infusion and advised for a few medical investigations for checking her recovery. Investigations revealed no further complications and a smooth recovery rate. She was discharged from the hospital in a very stable condition with haemoglobin of 10.4gm/dl.

Here, we would like to share a very important message with everyone. Over the counter pills should not be consumed at your own will. The medications which are prescribed by specialist doctors are given to an individual patient only after knowing the history of the patient, physical examination and also after checking the medical investigation reports. Hence please avoid consuming over the counter pills. because you are not aware about what negative reactions can occur inside your body. Consulting a specialist doctor before consuming any medication is safer than developing life threatening complications after consuming over the counterpills.