At 9 a.m. one morning, an ambulance screeched to a halt outside the hospital emergency department. A young woman was carried out, her face cyanotic, carotid pulse absent, pupils dilated, abdomen distended with shifting dullness. Recognizing the critical condition, I immediately organized the medical team for resuscitation: external cardiac compression, endotracheal intubation, intravenous push...Despite these emergency measures, the patient showed no response, her electrocardiogram remaining flat. After an hour, I reluctantly declared her dead.
Her boyfriend, who had rushed from a construction site, stood dazed in a tank top, his hair disheveled, staring at his girlfriend covered by a white sheet. He kept murmuring, "How could this happen? How could this happen?"
According to the escort's account, the deceased was surnamed Xu. She had come to Changsha with her boyfriend three years ago to work, living with him illegally. She had undergone three abortions. A month prior, after missing her period for 50 days, she sought an abortion at a private clinic. The procedure went smoothly, but she experienced minor vaginal bleeding afterward, along with nausea and vomiting.Last night, the patient suddenly experienced severe pain in her lower right abdomen, breaking out in a cold sweat and writhing in agony. Her boyfriend purchased 12 tablets of "XX Tong" (painkillers) from a pharmacy. She took two tablets at a time, five times in succession. While the pain eased somewhat, she gradually became disoriented and turned pale... leading to the scene described at the beginning of this article.
What caused my daughter's death? The deceased's parents, who arrived shortly after, questioned the cause of death and demanded an autopsy. The forensic examination revealed approximately 3,500 milliliters of accumulated blood and clots in the abdominal cavity, with rupture and hemorrhage of the right ovary. Both fallopian tubes were completely normal, and no other abnormalities were found. Pathological examination confirmed "right ovarian pregnancy" (a type of ectopic pregnancy).
Ectopic pregnancy refers to the implantation and development of a fertilized egg outside the uterine cavity, commonly occurring in the fallopian tubes, ovaries, abdominal cavity, cervix, or uterine horns. Implantation within the ovary is termed ovarian pregnancy, an extremely rare occurrence—approximately 1 in 9,000 to 60,000 pregnancies.The fertilized egg typically does not develop beyond three months, with most cases ending in early demise. However, a small number may continue to grow. Once ruptured, this can cause massive intra-abdominal hemorrhage and shock. The patient died due to rupture of the right ovary and hemorrhagic shock.
Though the cause of death was determined, the tragedy of Miss Xu's untimely demise due to misdiagnosis fills me with sorrow and regret. As a physician, countless "what ifs" from this case persistently linger in my mind.
—If the patient had maintained chastity, refrained from illicit sexual activity, and avoided multiple illegal abortions, the likelihood of ectopic pregnancy would have been significantly reduced.
—Had she sought gynecological examination at a qualified hospital after her missed period, the physician might have detected cervical tenderness on vaginal examination, noted uterine enlargement inconsistent with gestational age (typically smaller than in normal intrauterine pregnancy), and palpated a mass or mild tenderness in one adnexal region—all suggesting ectopic pregnancy.
——If an ultrasound were performed before the abortion, it could distinguish between intrauterine and ectopic pregnancy, preventing unnecessary procedures.
——If post-abortion examination routinely analyzed aspirated material, and no visible chorionic villi were found, sending the sample for pathology would prompt ectopic pregnancy suspicion if villi remained absent.—Even without the above tests, if ectopic pregnancy is suspected before the abortion, performing a posterior cul-de-sac puncture and aspirating non-clotting blood can achieve an 80–90% diagnostic accuracy, thereby preventing unnecessary abortions.
——Had the patient and her boyfriend recognized that severe abdominal pain could indicate an ectopic pregnancy, and avoided self-medicating with painkillers to mask symptoms, seeking prompt medical attention might have saved her life. Yet, the dead cannot be brought back. Though this is hindsight, I share it hoping unmarried couples may learn from this tragedy to prevent similar losses.