National: Woman who took abortion pills rushed to hospital after ectopic pregnancy rupture

A 24 year old woman required “immediate resuscitation” after presenting at University Maternity Hospital Limerick (UMHL) due to a “ruptured ectopic pregnancy (EP)” two weeks after having a medical termination of pregnancy (MTOP) .

An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes

The case report featured in the March 2024 edition of the Official Journal of the Irish Medical Organisation, where the authors – obstetricians and gynaecologists – said that it provided “insights into a serious and life-threatening event i.e maternal collapse due to a ruptured ectopic pregnancy after MTOP”. 

The case report elucidates “the association between induced abortion and EP and highlights MTOP as a risk factor for EP”.

The paper is entitled 'Medical Termination of Pregnancy – an Emerging Risk for Maternal Mortality'. 

In the case, the woman was brought to UMHL by ambulance with right lower abdominal pain and hypovolemic shock – an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body, which can cause many organs to stop working.

She was also hemodynamically unstable – suffering abnormal blood pressure – and “required immediate resuscitation”.

The woman in question had taken abortion pills under the care of her GP two weeks previously.

The report makes a reference that EP is a “significant cause” of maternal morbidity and mortality, and that healthcare providers “ideally should be able to diagnose and exclude women with ectopic pregnancy before a medical termination of pregnancy”.

At the end of the report there is a recommendation that asymptomatic women with certain “red flag risk factors for EP” get a diagnosis of IUP (an intrauterine pregnancy) before a medical termination.

The red flags include previous ectopic pregnancies, IUCD users and previous pelvic abscesses.

However, the medics also noted in the case report that their patient in this case had “no risk factors for EP”.

The report cites a reference that EP is uncommon among women presenting for abortion.

The full paper is available to read on www.imj.ie