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Ruptured ectopic pregnancy management in the COVID-19 pandemic era: a case report

  • I Gde Sastra Winata ,
  • Anton Supono ,


Introduction. COVID-19 protocol and the unavailability of proper instruments in the isolation room had complicated the usual protocol to diagnose and manage the medical and surgical conditions.  This article is about the first ruptured ectopic pregnancy cases encountered during the COVID-19 pandemic in Sanglah General Hospital. Considering the unique circumstances and the difficulty during establishing the diagnosis and conducting the management, we ought to present our experience through this article.

Case Description. This case report reviews a 24-years-old female, an asymptomatic COVID-19 case, who was diagnosed with ruptured ectopic pregnancy during appendectomy surgery in Sanglah General Hospital, Denpasar, Bali-Indonesia. The patient complained about mild lower right abdominal pain, with a clinical picture that supports acute appendicitis. However, the history taking revealed a history of post-curettage 15 days prior to admission due to vaginal bleeding suspected for incomplete abortion. Except for a positive pregnancy test, the clinical picture did not support a pregnancy nor a ruptured ectopic pregnancy. We still consider an ectopic pregnancy as no histopathological examination result was available to supports the previous vaginal bleeding was an intrauterine pregnancy. Further to complicate the problem, the patient was reactive for the COVID-19 screening test, thus requiring a COVID-19 protocol. As an ultrasound device was unavailable at the time in the isolation room, we could not assess for extrauterine pregnancy. Only during the surgical procedure for appendectomy, our surgical college notified us of the accompanying presence of sign of ruptured right ampullary pregnancy.

Conclusion. The COVID-19 isolation protocol and the unavailability of essential equipment and diagnostic tools in the isolation room could hinder the usual protocol used to diagnose and manage various medical and surgical problems. We hope this article could illustrate how COVID-19 had complicated unusual cases, thus reflect how important clinical judgment and infrastructure in our health care system.


  1. Hoffman B, Schorge J, Bradshaw K, Halvorson L, Schaffer J, Corton M. Williams Gynecology, Third Edition. 3rd ed. (Hoffman B, Schorge J, Bradshaw K, Halvorson L, Schaffer J, Corton M, eds.). United States: McGraw-Hill Education; 2016.
  2. Barnhart KT, Franasiak JM. ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018;131(3):e91-e103. doi:10.1097/AOG.0000000000002464
  3. Stulberg DB, Cain LR, Dahlquist I, Lauderdale DS. Ectopic pregnancy rates in the Medicaid population. Am J Obstet Gynecol. 2013;208(4):274.e1-274.e7. doi:10.1016/j.ajog.2012.12.038
  4. Birge O, Erkan MM, Ozbey EG, Arslan D. Medical management of an ovarian ectopic pregnancy: a case report. J Med Case Rep. 2015;9(1):290. doi:10.1186/s13256-015-0774-6
  5. Kementrian Kesehatan RI. Pedoman Pencegahan Dan Pengendalian Coronavirus Disease (COVID-19).; 2020. doi:10.33654/math.v4i0.299
  6. POGI. Panduan Alat Pelindung Diri (APD). Published 2020.
  7. Barash JH, Buchanan EM, Hillson C. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2014;90(1):34-40. doi:10.1111/1471-0528.14189
  8. Leveno KJ, Spong CY, Dashe JS, et al. Williams Obstetrics, 25th Edition. McGraw-Hill Education; 2018.
  9. Bourne T, Kyriacou C, Coomarasamy A, et al. ISUOG Consensus Statement on rationalization of earlyâ€pregnancy care and provision of ultrasonography in context of SARSâ€CoVâ€2. Ultrasound Obstet Gynecol. 2020;55(6):871-878. doi:10.1002/uog.22046
  10. Hansen KA, Stovall DW. Ectopic Pregnancy During Coronavirus Disease 2019 (COVID-19). Obstet Gynecol. 2020;136(2):288-290. doi:10.1097/AOG.0000000000003995
  11. Steier JA, Bergsjos P, Myking OL. Human chorionic gonadotropin in maternal plasma after induced abortion, spontaneous abortion, and removed ectopic pregnancy. Obstet Gynecol. 1984;64(3):391-394.

How to Cite

Winata, I. G. S., & Supono, A. (2020). Ruptured ectopic pregnancy management in the COVID-19 pandemic era: a case report. Bali Medical Journal, 9(3), 768–772.




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