A 34-Year-Old Pregnant Woman With Acute, Severe Abdominal Pain

Lars Grimm, MD

Disclosures

July 15, 2015

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 34-year-old woman presents to the emergency department (ED) with a 2-hour history of severe abdominal pain, two episodes of light-headedness, and loss of consciousness. She states that she is about 6 weeks pregnant and that the pain started suddenly the morning of presentation. She went to the bathroom and sat on the toilet when she felt light-headed. After her second time passing out, she alerted her husband, who called for an ambulance. She denies any vaginal bleeding or discharge. No nausea or vomiting is reported, and the patient has not experienced any fevers.

The patient has visited an obstetrician for prenatal care but has not yet had ultrasonography. The patient is currently G3P1011; she had a spontaneous abortion that complicated a prior pregnancy 4 years ago. She has no history of pelvic inflammatory disease or prior ectopic pregnancy. She is currently not undergoing ovulatory induction. She does not have an IUD. The patient has no chronic medical problems and takes no medications regularly. She does not drink alcohol and does not use any illicit substances.

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