A case of eclampsia with a progressive 5-month ectopic (tubal) pregnancy

Patient 3., M., 32 years old (East bol. No. 465), a collective farmer, was admitted to the hospital on 28 / X 36 years with complaints of facial edema and mild pain in the lower abdomen. Until now, she has not noted any diseases. B-Naya considers herself pregnant since June 1936, when the menstruation, which had come neatly before that and established from the age of 14, stopped. Pregnancy was one 10 years ago and ended in normal urgent labor. He denies abortion and gonorrhea. In July 36, there were some seizures, expressed by loss of consciousness and convulsions. The patient did not seek help anywhere. The patient comes under the supervision of doctors for the first time on September 20, 36. During examination at that time, it was found in her: the uterus is well defined on the left, enlarged, mobile, and on the right of the uterus there is a tumor that is closely connected with the uterus, its upper border is at the level of the navel , and the left one goes slightly beyond the middle line. Slightly below the navel and to the right of it, the fetal heartbeat is well heard. The patient was diagnosed with Graviditas extrauterina progressiva. The patient categorically refused the proposed operation. On September 25, 36, the patient was advised to go to the Bugulma interdistrict hospital, where the gynecologist, consulting the patient, suspected pregnancy in the uterine horn, and suggested an operation. The patient, having spent two days in the hospital, refused the operation and, having declared that she would go to the operation in her hospital, left Bugulma. Arriving home, the patient did not show up at the hospital, but began her usual work. 25.X.36 after hard work (dug up a garden and carried sacks of potatoes), the patient felt aching pains in the lower abdomen. The next day, she felt a severe headache and noticed swelling in her face and arms, which led her to the hospital for the second time. The patient is of average height, regular constitution, visible mucous membranes and skin are normally colored, with a slight bluishness on the lips, the face and hands are swollen. The upper border of the heart is at the lower edge of the 3 ribs, the right one along lin. parasternalis sin., left — 1. mammilaris. Heart sounds are clean. Pulse 90 VH, tense. The temperature is 36.8. On the part of the lungs, no pathological changes were noted. The spleen and liver are not palpable. The abdomen is irregular; the right side is swollen, the left sunken. On palpation in the abdominal cavity, an oblong-shaped tumor is felt to the right of the uterus, closely adhered to it, painful when pressed. The upper border of the tumor extends 2 fingers above the navel, the left one goes beyond the midline of the abdomen at the level of the navel. On the right above the tumor, the fetal heartbeat is clearly heard, which does not coincide with the mother's pulse. The entrance to the vagina is slightly bluish in color. Portio vaginalis uteri not softened, vaults are free, ripples art. uterinae no. The uterus is enlarged, palpable to the left of the tumor, mobile and connected with the tumor by a bridge. Small parts of the fetus are not determined in the study. There were no urinary disorders. When boiled, urine contains a large amount of protein. On 27.X.36, shortness of breath appeared in the evening. The patient was strongly offered an operation, which she refused. On 30.X.36, nausea appeared, in the evening vomiting of herbs, headaches became unbearable, at 9 o'clock in the evening an attack of eclampsia was noted. Treatment according to Stroganov was started. In ½ hour, a second seizure followed and 2 hours later a third, very intense ... The patient is unrecognizable from the strong swelling of the face. The urine contains a huge amount of protein. The patient agreed to the operation.