Ectopic Erica — Ectopic Pregnancy: The Pain on One Side and the Shoulder That Screams Rupture
Missed period, one-sided pain, spotting — then shoulder pain means it has burst
One missed period, pain on one side, a little spotting — and the moment her shoulder starts to ache, Erica knows the tube has burst.
Erica implants where she should not. An ectopic pregnancy grows outside the uterus, most often in a fallopian tube, and the tube cannot stretch forever. The classic triad is a missed period, one-sided lower abdominal pain and light vaginal spotting or bleeding. Risk factors include pelvic inflammatory disease, prior ectopic pregnancy, tubal surgery and IUD use. When the tube ruptures, blood pools under the diaphragm and the client feels referred pain in the shoulder — that shoulder pain with dizziness, a falling blood pressure and a rising heart rate is a surgical emergency. hCG rises more slowly than expected and ultrasound shows no pregnancy inside the uterus.
Read Ectopic Erica's full story →The story arc
The setup
A client reports a missed period, mild left-sided pelvic pain and light spotting.
The turn
Her hCG is rising, but far more slowly than a normal pregnancy, and ultrasound shows an empty uterus.
The crisis
She suddenly reports sharp shoulder pain, feels faint, and her blood pressure is dropping.
The save
Erica moves fast: large-bore IV access, blood type and crossmatch, and straight to surgery.
NCLEX study section — Ectopic Pregnancy: The Pain on One Side and the Shoulder That Screams Rupture
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Maternal & Newborn
Take this chapter into practice questions on the same topic.