The following is a case report from one of our volunteer doctors:
VJ is a 35-year-old female who was admitted overnight to Kivunge Cottage Hospital with abdominal pain and nausea/vomiting. She was diagnosed with “Typhoid fever” based on her symptoms, and tests indicated that she might have a slight urinary tract infection. The patient was started on antibiotics for her presumed UTI and her typhoid fever was managed with supportive care.
Upon hearing that a pregnant patient was admitted to the hospital with severe abdominal pain, I immediately sent for her to come to the maternity ward for ultrasound evaluation. On exam, the patient had severe bilateral lower quadrant abdominal pain, and CMT on pelvic exam; I was concerned that she was developing an acute abdomen. On ultrasound, there was no intrauterine pregnancy. As I scanned to the right, there was a clear live ectopic pregnancy, measuring about 7 weeks, with a fetal heart rate of 145. There was also a moderate amount of free fluid in the pelvis.
I immediately placed an IV and started bolusing fluids. While the patient’s initial vital signs had been normal, her repeat BP was 80/60 – she was becoming unstable. Unfortunately, we don’t have the resources to perform emergency surgery at Kivunge, so I called Dr. Tarek, the head OB/Gyn doctor in Mnazi Moja (MMH), the referral hospital. I explained to him that I was transferring a patient with an unstable ectopic pregnancy that required immediate surgical management. He said he would get the Operating Theatre ready.
The patient left in the ambulance to make the 50 minute trip to MMH at 2:00 pm. At 4:00 pm I received word from Dr. Tarek that the patient was in the Theatre. They found a ruptured right ectopic pregnancy with 2 liters of blood in the abdomen. The surgical team removed the fallopian tube and she was resuscitated appropriately with blood products. The next day I heard from Dr. Tarek that the patient was doing well after surgery and was discharged home on post-op day 2.
This important life-saving diagnosis could not have been made without the ultrasound that HIPZ provided for Kivunge hospital. Without the ultrasound diagnosis of ruptured ectopic pregnancy, the patient would likely have been transferred with the diagnosis of “typhoid fever” and might have sat for days at MMH without getting the surgical care she needed, as typhoid fever is not considered an emergency. I am so thankful for life-saving care that the new ultrasound at Kivunge can provide.