Case 10 · Obstetrics
Ruptured ectopic pregnancy
A 26-year-old woman collapses in the toilet with sudden pain low in her abdomen. She does not know she is pregnant, and she is bleeding into her abdomen faster than her pulse and BP admit. Test for pregnancy, scan at the bedside, resuscitate with blood rather than litres of fluid, and get her to theatre before she decompensates.
About this case
What you will practise
Learning objectives
- Suspect ectopic pregnancy in any woman of reproductive age with abdominal pain or collapse, and do a pregnancy test at once.
- Recognise haemorrhagic shock early in a young woman who compensates well, using the shock index.
- Confirm haemoperitoneum with a bedside scan without moving an unstable patient out of resus.
- Resuscitate with blood and limited crystalloid until the bleeding is controlled.
- Book category-1 theatre early, explain and take consent, and prepare her for a safe induction.
- Remember anti-D for a woman who is RhD negative.
Key decisions this case tests
- Could she be pregnant, even though she says she is not?
- Bedside scan, radiology, or straight to theatre?
- How much clear fluid, and what BP are you aiming for before surgery?
- When do you call for blood?
- Which tests and drugs would only waste her time?
Reference basis
- NICE guideline NG126: Ectopic pregnancy and miscarriage: diagnosis and initial management (2019, updated 2023).
- RCOG/AEPU Green-top Guideline No. 21: Diagnosis and management of ectopic pregnancy (2016).
- World Health Organization. Managing complications in pregnancy and childbirth, 2nd edition (2017).
- Advanced Trauma Life Support principles for haemorrhagic shock.
Content version 1.0 · November 2026 · clinical review pending. See the Clinical content policy.
Before you start
The physiology is a simplified teaching model: bleeding rate, compensation, the response to induction and the effects of transfusion are timed for learning, not prediction. Doses follow the cited guidelines but have not yet been signed off by a clinician.
Visle is for education only and is not medical advice. Sudden abdominal pain or fainting in early pregnancy is an emergency: get skilled help immediately.
Ready for another emergency?
Case 09 puts you in a labour room where a mother will not stop bleeding after the birth.