Ectopic Pregnancy At Sea

A cabin stewardess presented with a short history of dysmennorhoea followed by a syncopal episode. The ship was 20 hours sail time from the next port. Clinical signs included pallor, hypotension, lower abdominal tenderness and distension. Urine HCG was positive for pregnancy. The working diagnosis of ectopic preganacy was made and she was resuscitated with IV fluids in the critical care unit. Her haemoglobin dropped down to 7g/dl over an hour and the decision was made to transfuse her with fresh whole blood using the comprehensive protocols contained within our fleet medical regulations. Following transfusion of several units, her condition temporarily stabilized but significant internal bleeding persisted. Emergency arrangements were made for a helicopter evacuation to a hospital in the nearby island of Rhodes. She underwent emergency surgery and made a full recovery.