Mrs B, a 28-year-old woman, presented to the rural health clinic with severe lower abdominal pain and vaginal bleeding of two days' duration. She reported missing her menstrual period for six weeks and had taken a home pregnancy test, which was positive. Over the past few days, she had been experiencing mild cramping, which suddenly intensified. The pain was sharp and localized to the right side of her lower abdomen. She also reported feeling lightheaded and weak.

- Two previous normal vaginal deliveries at home with no complications.

- History of untreated pelvic inflammatory disease (PID) one year ago, following a sexually transmitted infection (STI), due to lack of access to healthcare.

- No previous surgeries.

Mrs B lives in a remote village with limited access to healthcare facilities. She must travel over 20 kilometers to reach the nearest clinic. Due to financial constraints, she only seeks medical help when symptoms become severe. Her diet is poor, and she has limited access to clean water and sanitation.

- Vital Signs: BP 90/60 mmHg, HR 110 bpm, RR 24 breaths/min, Temp 37.2°C

- General: Pale, sweating, and appears anxious.

- Abdominal Examination: Tenderness and guarding in the lower abdomen, particularly on the right side. Rebound tenderness present.

- Speculum Examination: Moderate vaginal bleeding, cervical os closed.

- Bimanual Examination: Right adnexal tenderness with a palpable mass.

- Transabdominal Ultrasound: Revealed an empty uterus with a right adnexal mass and free fluid in the pelvis, suggestive of a ruptured ectopic pregnancy.

- Hemoglobin: 7.5 g/dL (indicating anemia likely due to blood loss).

Ruptured ectopic pregnancy.

Mrs B was immediately stabilized with intravenous fluids and blood transfusion. Due to the severity of her condition and the lack of surgical facilities in the local clinic, she was referred urgently to a regional hospital for emergency surgery. Unfortunately, the transport to the hospital was delayed due to poor road conditions, and Mrs B’s condition deteriorated rapidly. Upon arrival, she underwent emergency laparotomy, where a ruptured right fallopian tube was found and removed. She was transferred to the intensive care unit post-operatively and received further blood transfusions. 

Mrs B recovered slowly but experienced significant physical and emotional trauma. She was counselled on the importance of early antenatal care and the risks of future pregnancies, especially given her history. Access to healthcare remains a challenge for her and many women in her region.