Annals of Emergency Medicine
Volume 43, Issue 3 , Pages 382-385, March 2004

Ruptured heterotopic pregnancy presenting with relative bradycardia in a woman not receiving reproductive assistance☆

  • Michael P Somers, MD

      Affiliations

    • Department of Emergency Medicine, University of Virginia Health System, Charlottesville, VA, USA
    • Corresponding Author InformationAddress for correspondence: Michael P. Somers, MD, Department of Emergency Medicine, PO Box 800699, University of Virginia Health System, Charlottesville, VA 22908-0699; 434-982-1800, fax 434-924-4118
    • ,
  • Michelle Spears, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA, USA
    • ,
  • Arthur S Maynard, MD

      Affiliations

    • Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA
    • ,
  • Scott A Syverud, MD

      Affiliations

    • Department of Emergency Medicine, University of Virginia Health System, Charlottesville, VA, USA

Received 16 May 2003; received in revised form 13 August 2003; accepted 19 August 2003.

Abstract 

We report a case of heterotopic pregnancy in a woman who had not undergone in vitro fertilization or any other reproductive assistance. The patient failed to mount a tachycardic response to hemorrhagic shock. Bradycardia is a well-established phenomenon in the setting of hemoperitoneum and particularly with ruptured ectopic pregnancy. This is a case of heterotopic pregnancy with relative bradycardia in a woman without predisposing factors for heterotopic pregnancy. We make suggestions on avoiding common pitfalls in the emergency department diagnosis of heterotopic pregnancy. We also address the similar clinical presentations of heterotopic pregnancy and intrauterine pregnancy with ruptured corpus luteum cyst.

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☆ The authors report this study did not receive any outside funding or support.Reprints not available from the authors.

PII: S0196-0644(03)00827-8

doi:10.1016/j.annemergmed.2003.08.004

Annals of Emergency Medicine
Volume 43, Issue 3 , Pages 382-385, March 2004

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