Some years ago I was woken up by my junior doctor who told me he had just treated a young single girl with a haemoglobin of 6.8g/dL ( normal: 12-15) at the casualty for anaemia. He then told me not to worry he would be admitting the girl to the female medical ward shortly. I said ok and was about to go back to sleep when an anxiety struck me. It seemed odd that the girl should present to the casualty in the early hours of the morning. Chronic anaemia would commonly come to the day outpatient clinic. I immediately dressed up and got into my car and drove to the hospital.
The girl was still in the casualty. She looked pale and was lying still .After examining her and excluding conditions such as an appendix, I did a simple "rocking vagina" test and she cringed with pain and immediately I knew she was having an ectopic pregnancy which had been bleeding into her abdomen and called my Obstetrics and Gynaecology colleague to come in and take over the case. Yes, she had an ectopic and was operated on first thing that morning.... I saved her life!
I could not blame my officer as he thought an ummarried female could not be pregnant!
Last year a married woman came to see me and complained that her period had been prolonged. I asked about her menstrual history and she told me that she had been on oral contraceptives for almost a year ( she got her supply direct from a pharmacist!). And she just stopped using it a few weeks ago so I thought this could have been an erratic bleeding following use of the contraceptive and usually a woman would experience a prologed period of no menses or sometimes heavy ones after they stop the contraception. I advised her along that line of thinking.
Apparently she continued to bleed and someone at the hospital did a pregnancy test and found that it was positive! Gosh the woman had an ectopic pregnancy, possibly a small one but ectopic pregnancy still the same and I had missed it. I take it as a good lesson and not to just stick to the history but to look out for possibility that the contraception could have failed and thus have a high index of suspicion on her pregnancy status.
We learn from our dear patients, they are our best teachers.
The girl was still in the casualty. She looked pale and was lying still .After examining her and excluding conditions such as an appendix, I did a simple "rocking vagina" test and she cringed with pain and immediately I knew she was having an ectopic pregnancy which had been bleeding into her abdomen and called my Obstetrics and Gynaecology colleague to come in and take over the case. Yes, she had an ectopic and was operated on first thing that morning.... I saved her life!
I could not blame my officer as he thought an ummarried female could not be pregnant!
Last year a married woman came to see me and complained that her period had been prolonged. I asked about her menstrual history and she told me that she had been on oral contraceptives for almost a year ( she got her supply direct from a pharmacist!). And she just stopped using it a few weeks ago so I thought this could have been an erratic bleeding following use of the contraceptive and usually a woman would experience a prologed period of no menses or sometimes heavy ones after they stop the contraception. I advised her along that line of thinking.
Apparently she continued to bleed and someone at the hospital did a pregnancy test and found that it was positive! Gosh the woman had an ectopic pregnancy, possibly a small one but ectopic pregnancy still the same and I had missed it. I take it as a good lesson and not to just stick to the history but to look out for possibility that the contraception could have failed and thus have a high index of suspicion on her pregnancy status.
We learn from our dear patients, they are our best teachers.
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