When ruptured, a tubal ectopic pregnancy may present with lower abdominal pain, vaginal bleeding, signs of collapse and shock, and extreme tenderness in pelvis. Shoulder tip pain may be present. Treatment includes rapid resuscitation and surgery – salpingectomy (laparotomy or laparoscopy) to stop bleeding. The differential diagnosis includes appendicitis and complication of an ovarian cyst. Investigations include pelvic ultrasound, betaHCG and full blood count.
An incomplete abortion (miscarriage) may result in POC distending the cervix. The woman may present in a collapsed or shocked state. Speculum examination should be performed and any POC removed either digitally or with sponge forceps. Resuscitation and evacuation of the uterus under GA should follow.
The most common complications of ovarian cysts resulting in an emergency presentation include rupture, torsion and haemorrhage. Symptoms include pelvic pain which may be of sudden onset. Cramping pain and nausea often associated with torsion of the ovary. Investigations include pelvic ultrasound, betaHCG and full blood count. Surgery may be necessary.