Abstract
Precipitous delivery in the emergency department is a high-acuity, low-occurrence event that requires rapid recognition and interdepartment cooperation to prevent fetal and maternal morbidity and mortality. Prompt recognition of the peripartum state can be delayed by reported usage of long-acting contraception and concurrent distracting complaints. In this case report, a young female presented to the emergency department with epigastric abdominal pain in the setting of recent workup for biliary colic and multiple doses of long-acting, depot contraceptive agents. Early utilization of bedside ultrasound confirmed a full-term, intrauterine pregnancy as well as an impacted gallbladder stone, followed by a precipitous footling breech presentation that required an emergent cesarean section.
Highlights
Emergency physician assessment of young, sexually active female patients who present with abdominal complaints should always consider pregnancy-related medical conditions
A 28-year-old female presented to the emergency department (ED) with crampy, epigastric abdominal pain which had worsened over several hours
The most common form of birth control used in the United States is the oral contraceptive pill, with annual failure rates estimated at approximately 9% for the general population
Summary
Emergency physician assessment of young, sexually active female patients who present with abdominal complaints should always consider pregnancy-related medical conditions. A 28-year-old female presented to the emergency department (ED) with crampy, epigastric abdominal pain which had worsened over several hours. This pain was intermittent over the past six months, and was associated with food intake and Depo-Provera® (depot medroxyprogesterone acetate [DMPA]) injections, most recently administered one month prior to this visit. The patient was given 2 g of magnesium intravenously by obstetrics and gynecology, and consented to an emergent cesarean section due to the footling breech presentation in the setting of high-risk pregnancy without prenatal care. Our patient eventually had an uneventful laparoscopic cholecystectomy 15 months later
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