A complication of ruptured ectopic pregnancy is?

NIMHANS Nursing Officer - 2021

Obstetrics & Gynaecology

Medium

Appeared in: NIMHANS Nursing Officer - 2021

Explanation

A ruptured ectopic pregnancy leads to significant bleeding into the abdominal cavity, a condition known as hemoperitoneum.
The presence of blood in the peritoneum causes inflammation (peritonitis), which is a major trigger for a systemic inflammatory response.
Fever is a cardinal sign of this systemic inflammation or a subsequent secondary infection developing in the pooled blood.
Medical literature confirms that a significant number of women with ruptured ectopic pregnancies develop leukocytosis (high white blood cell count), an objective sign of inflammation/infection that correlates with fever.

Option A: Nausea is a very common symptom of early pregnancy in general, due to hormonal changes (hCG). It is not a specific complication that arises from the rupture itself.
Option B: While massive blood loss can cause systemic effects, chest pain is not a classic or direct complication. The characteristic referred pain from diaphragmatic irritation due to hemoperitoneum is shoulder-tip pain (Kehr's sign).
Option C: Quickening is the term for a pregnant woman's first perception of fetal movement, which typically occurs between 16 and 25 weeks of gestation in a normal intrauterine pregnancy.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Ruptured Ectopic Pregnancy as background academic context rather than a clinical decision trigger.
A ruptured ectopic pregnancy is a life-threatening surgical emergency. Nurses must be able to rapidly identify signs of hemorrhagic shock (tachycardia, hypotension, pallor, dizziness) and alert the medical team immediately.
Prioritizing care involves the ABCs (Airway, Breathing, Circulation). This includes establishing two large-bore IV lines for rapid fluid resuscitation and blood product administration.
Continuous monitoring of vital signs is crucial to track the patient's hemodynamic status and response to interventions while preparing for emergency surgery.

How to Approach the Question

First, identify the key concepts in the question: "complication" and "ruptured ectopic pregnancy." This directs you to think about the immediate, life-threatening consequences of the rupture event.
Recall the pathophysiology of a rupture: the fallopian tube tears, causing massive internal bleeding (hemoperitoneum).
Evaluate each option in the context of this internal bleeding.
Eliminate 'Quickening' as it relates to a normal, second-trimester pregnancy.
Eliminate 'Nausea' as it's a general symptom of early pregnancy, not a specific result of the rupture.
Compare 'Chest pain' and 'Fever'. While pain is expected, the classic referred pain is in the shoulder tip. Fever, however, is a direct systemic response to the inflammation (peritonitis) caused by blood in the abdomen or a subsequent infection.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 18-33

E6 Medicine Harrison 22e Part 2 p. 1040-1042