A female reports in OPD with a history of severe pain in the lower abdomen and dizziness for 4 hours. On enquiring, she informs that she is overdue for menstruation by 15 days. The probable reason could be:

1. A

   Missed abortion

2. B

   Ectopic pregnancy

3. C

   Molar pregnancy

4. D

   Septic abortion

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Explanation

• The patient's presentation includes a classic triad of symptoms for a ruptured ectopic pregnancy: amenorrhea (15 days overdue), severe lower abdominal pain, and dizziness.
• Amenorrhea suggests an early pregnancy (around 6 weeks), which is a typical time for tubal rupture.
• Severe, sharp, or stabbing lower abdominal pain is characteristic of tubal rupture and peritoneal irritation from blood.
• Dizziness is a sign of hypovolemia and hemodynamic instability (shock) resulting from significant internal hemorrhage.
• Ectopic pregnancy is a life-threatening emergency that requires immediate diagnosis and intervention to prevent fatal blood loss.

Why Other Options Were Wrong

• Option A: A missed abortion is when the fetus has died but remains in the uterus. It typically presents with a decrease in pregnancy symptoms and possibly some brownish vaginal discharge. Severe pain and dizziness (signs of shock) are not characteristic.
• Option C: A molar pregnancy (hydatidiform mole) involves abnormal growth of trophoblastic tissue. It usually presents with exaggerated signs of pregnancy, such as severe nausea and vomiting, a uterus that is larger than expected for the gestational age, and often vaginal bleeding described as 'grape-like vesicles'. Acute severe pain and shock are less common initial presentations.
• Option D: A septic abortion is an abortion associated with a uterine infection. The key features are signs of infection, such as high fever, chills, and a foul-smelling, purulent vaginal discharge. The patient's primary complaints are pain and dizziness, not signs of infection.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Recognition of signs and symptoms of early pregnancy complications, specifically ruptured ectopic pregnancy as background academic context rather than a clinical decision trigger.
• A ruptured ectopic pregnancy is one of the most critical emergencies in obstetrics. A nurse must be able to quickly recognize the signs (amenorrhea, pain, shock) and facilitate immediate medical and surgical intervention to save the patient's life.
• The nurse's role includes rapid assessment of vital signs (tachycardia, hypotension), preparing for IV fluid resuscitation and potential blood transfusion, and readying the patient for emergency surgery (laparoscopy or laparotomy).
• Patient education is vital. Women with risk factors for ectopic pregnancy (e.g., history of pelvic inflammatory disease, previous tubal surgery, or prior ectopic pregnancy) should be counseled to seek immediate care if they miss a period and develop abdominal pain.

How to Approach the Question

• First, analyze the patient's chief complaints: severe lower abdominal pain and dizziness.
• Next, consider the relevant history: she is 15 days overdue for her period, which strongly suggests an early pregnancy.
• Synthesize these three key findings: amenorrhea + severe abdominal pain + dizziness (a sign of shock/instability).
• Recognize this combination as the classic clinical triad for a ruptured ectopic pregnancy, a life-threatening condition.
• Evaluate the other options. Missed abortion typically lacks severe pain and shock. Molar pregnancy has other specific signs (large uterus, hyperemesis). Septic abortion is characterized by infection (fever, purulent discharge).
• Conclude that ectopic pregnancy is the most probable and urgent diagnosis based on the presented signs and symptoms.

Concept Tested & Keywords

• Concept Tested: Recognition of signs and symptoms of early pregnancy complications, specifically ruptured ectopic pregnancy.
• Stem keywords: severe pain in the lower abdomen, dizziness, overdue for menstruation
• Lead-in keywords: probable reason
• Clinical cues: The combination of amenorrhea, severe abdominal pain, and dizziness is a classic triad for a ruptured ectopic pregnancy.

Question ID

Qw0B1vdsa6BrROnmTP0S2J

Copy ID

Reference Book

E6 Obstetrics Williams p. 18-33

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

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 6-11