In anticipation of episode number 23 on vaginal bleeding in early pregnancy with Dr. Ross Claibault and Dr. David Dyshensky, I've got here with us Dr. Ross Claibow, who's going to give us his best case ever. Ross, let it rip.

Okay, I just want to remind you of 32 years, so I may have been a few best cases which I missed,

but the one most recent that stands out in my mind is that of a young prime imp who's 28 years

old, who had a pregnancy 18 weeks when she presented to the emergency department.

And she had been seen about two or three weeks earlier in the same emergency department in Toronto,

had diagnosed an interritorial pregnancy that was normal, viable, and had also been diagnosed with the coexistent fibroid in the uterus.

And the diagnosis at that time for her pain had been degrading fibroid, and she had been given a prescription for Percocet, and followed

up. And she came in after 24 hours of severely increasing pain in the same area, arrived in the

department. Young, as I said, primit woman of Pakistani origin had been taking Percocet regularly,

with normal vital signs, saturations, but with an extremely

tender uterine fundus when I examined her. And this was just in the infancy of our ultrasound

skills, but I remember having a learner on with me. We went with the ultrasound probe and we did

a quick bedside ultrasound, and we found

free fluid in Morrison's pouch and the left upper quadrant, but we also at the same time

saw what looked like a normal 17-week interuterine pregnancy with a beating heart and actively moving.

Patient continued to require huge doses of narcotics, asking constantly for morphine,

fentanyl that we were giving to the emergency department.

Her vitals didn't fluctuate very much, maybe at most went down to about 97 systolic and her

systolic blood pressure.

Blood work didn't help very much.

Beta was appropriate for 52,000 for that stage of pregnancy.

White count a little bit elevated, which is again normal for that stage of pregnancy. At the time, I wasn't as confident with my ultrasound skills. I centered for a formal one, and they diagnosed, again, a live interuterine pregnancy with, quote, ascites. I was pretty convinced from my exam that this wasn't ascites, that there was something going on that looked clinically like a uterine rupture, which we know it doesn't usually happen in the primip patient and is a very

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