Abdominal pain is the most common symptom in ruptured ectopic pregnancy. 127 Non-ruptured ectopic pregnancies generally present with bleeding( brown being the most common) due to low progesterone and consequent shedding of the decidua.
Regardless of the diagnosis, vital signs that deviate from normal and severe pain( such as torsion or ruptured cysts) warrant prompt medical assessment.
Problems occurring from 20 weeks onwards
Pregnant women from 20 weeks gestation may present with the following obstetric conditions:
• Antepartum haemorrhage
• Preeclampsia( including eclampsia)
• Pre-term rupture of the membranes and labour.
Hypertension(> 140 / 90) is a particularly important sign to alert the Triage Nurse to a more serious problem. The presence of the associated symptoms of severe preeclampsia warrant urgent medical assessment. These include:
• Headache
• Visual disturbances
• Epigastric pain
• Right upper quadrant( RUQ) pain
• Non-dependent oedema.
53
These women are at risk of fitting and placental abruption, and the foetus has a higher risk of placental insufficiency.
There is a correlation between the degree of hypertension and complications such as cerebral haemorrhage.
• Antepartum haemorrhage is defined as > 15 mL of blood loss from the vagina from 20 weeks gestation.
• Common causes include placenta praevia and placental abruption.
• In placenta praevia, blood loss is usually visible PV and is not usually accompanied by pain.
• In placental abruption, the primary symptom is abdominal pain. The associated blood loss may be concealed between the placenta and uterus. Haemodynamic changes are only seen with big bleeds, smaller bleeds may be difficult to detect or more easily detected with an abnormal cardiotocograph( CTG). The main signs and symptoms are haemodynamic changes associated with hypovolaemic shock and abdominal pain.
Postnatal women may present with the following:
• Secondary postpartum haemorrhage ± puerperal sepsis
• Mastitis
• Wound infection
• Eclampsia
• Postpartum cardiomyopathy
• Postnatal depression.
Department of Health and Ageing – Emergency Triage Education Kit