A young woman in custody at a large urban jail has continuing abdominal pain over a 14 hour period. She is found unresponsive in her cell and rushed to the hospital where she is pronounced dead on arrival. Autopsy reveals a ruptured ectopic pregnancy. Was this death avoidable?
Ectopic pregnancy, where a fertilized ovum implants somewhere outside the uterus, is an emergency event every correctional nurse should consider when confronted with abdominal pain in a female inmate of reproductive age. Indeed, this condition is particularly common among women with a history of genital infections or infertility. Smoking also increases risk. Therefore, the female inmate population is at increased risk for ectopic pregnancy.
Potential causes of acute pelvic pain are
- Ectopic Pregnancy
- Ovarian Cyst or Torsion
- Pelvic Inflammatory Disease
Abdomenal pain caused by ectopic pregnancy can include vaginal bleeding. If pregnancy status is unknown, obtain a urine pregnancy test while contacting the physician. Patients with this condition can become unstable quickly. If a tubal rupture takes place, the pain will intensify and signs of shock such as low blood pressure and rapid thread pulse will be evident. Intraperitoneal hemorrhage can cause referred pain to the shoulder area and a very tender abdomen.
This is a medical emergency requiring fast action and immediate transport to acute care. Initiate emergency protocols which can include establishing an intravenous access and fluid loading. Seek immediate medical evaluation for any potentially pregnant patient with unexplained abdominal pain. Ruptured ectopic pregnancies is a leading cause of maternal mortality in the first trimester resulting in 10-15% of all maternal deaths. Shock and death can follow quickly and immediate stabilization and transport to emergency treatment is necessary.
Have you had an experience with an ectopic pregnancy in a jail or prison setting? Tell us your story in the comments section of this post.