Emergency measures for hemorrhagic shock due to ruptured tubal pregnancy

Mar 25, 2023 Source: Cainiu Health

Dr. Zhang Lu

Introduction

Emergency measures for ruptured tubal pregnancy with massive hemorrhage include immediate emergency management, fluid resuscitation, blood transfusion, and salpingectomy. It is important to abstain from sexual intercourse for 1 to 3 months after ectopic pregnancy surgery to prevent infection. Contraception should be used because the uterus is injured during surgery, and becoming pregnant immediately after surgery is very dangerous.

Ectopic pregnancy rupture in the fallopian tube leading to massive hemorrhage requires emergency measures including immediate first aid, fluid and blood transfusion therapy, and salpingectomy. It is recommended to seek prompt medical attention and receive treatment based on individual circumstances.

1. Emergency Management

If a ruptured ectopic pregnancy occurs in the fallopian tube, it may lead to severe abdominal pain and massive internal bleeding, resulting in pallor and a sharp drop in blood pressure. When patients exhibit these symptoms, immediate emergency measures should be taken. Position the patient lying down with head low and feet elevated, keep them calm and minimize movement to reduce bleeding, and ensure warmth.

2. Vital Signs Monitoring

Quickly connect the patient to a cardiac monitor and closely observe vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation. Blood pressure reflects the patient’s circulatory status; changes in heart rate can indicate the severity of blood loss and cardiac compensation; respiratory rate and oxygen saturation reflect respiratory function and oxygenation levels.

3. Administration of Hemostatic Medications

During preparation for surgery and blood/fluid resuscitation, hemostatic drugs may be used appropriately to temporarily control bleeding. Commonly used agents include tranexamic acid, which inhibits fibrinolysis and thus promotes clotting. However, such medications are only adjunctive in cases of ruptured tubal pregnancy and cannot replace surgical hemostasis.

4. Fluid Resuscitation and Blood Transfusion

Once a tubal pregnancy ruptures, complications such as shock may occur. Adequate oxygen supply must be ensured, intravenous access established rapidly, and blood prepared promptly. Fluids and blood should be administered quickly to correct shock. The most critical step is simultaneous administration of blood and fluids during laparotomy, along with anti-shock treatment and timely surgical control of bleeding. After bleeding is controlled, the decision to preserve or remove the fallopian tube can be made accordingly.

5. Salpingectomy

In cases of massive hemorrhage due to ruptured tubal pregnancy where the patient's condition is extremely critical, salpingectomy may be considered—especially for patients who do not plan to have future pregnancies.

Note: Sexual intercourse should be avoided for 1–3 months after ectopic pregnancy surgery to prevent infection. Effective contraception is advised because the uterus sustains trauma during surgery, and immediate subsequent pregnancy poses significant risks.

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