{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T08:09:30Z","timestamp":1770451770704,"version":"3.49.0"},"reference-count":4,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,6,15]]},"abstract":"<jats:p>A case of a 37-year-old female primagravida who attended the emergency department (ED) via ambulance in hypotensive shock. She was 10 weeks pregnant, but had an inevitable miscarriage confirmed in the local Early Pregnancy Unit 3 weeks previously. She was hypotension (90\/60\u00e2\u20ac\u2030mm Hg), bradycardic (45 bpm) and was peripherally shut down. A provisional diagnosis of haemorrhagic shock was made, but despite intravenous fluid challenges, she appeared to be deteriorating, so a major haemorrhage protocol was activated. On examination, there was some vaginal bleeding and a protruding sac noted. The gynaecology registrar was informed and performed an Evacuation of the Retained Products of Conception in the ED. This gave instant relief to the patient and her blood pressure and heart rate became normal over a few minutes. She went on to make a full recovery. This case provides useful learning points for doctors working in the ED and other urgent care settings.<\/jats:p>","DOI":"10.1136\/bcr-2017-220452","type":"journal-article","created":{"date-parts":[[2017,7,14]],"date-time":"2017-07-14T07:52:15Z","timestamp":1500018735000},"page":"bcr-2017-220452","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Cervical shock: a complication of incomplete abortion"],"prefix":"10.1136","volume":"2017","author":[{"given":"Julian David","family":"Birch","sequence":"first","affiliation":[{"name":"Emergency Department, John Radcliffe Hospital, Oxford, Oxfordshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Divyansh","family":"Gulati","sequence":"additional","affiliation":[{"name":"Emergency Department, John Radcliffe Hospital, Oxford, Oxfordshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachin","family":"Mandalia","sequence":"additional","affiliation":[{"name":"Emergency Department, John Radcliffe Hospital, Oxford, Oxfordshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,7,14]]},"reference":[{"key":"2025082805170060000_2017.jul14_2.bcr-2017-220452.1","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.jmwh.2009.08.007","article-title":"Assessment and management of bleeding in the first trimester of pregnancy","volume":"54","author":"Snell","year":"2009","journal-title":"J Midwifery Womens Health"},{"key":"2025082805170060000_2017.jul14_2.bcr-2017-220452.2","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.pop.2011.11.004","article-title":"First trimester complications","volume":"39","author":"Martonffy","year":"2012","journal-title":"Prim Care"},{"key":"2025082805170060000_2017.jul14_2.bcr-2017-220452.3","unstructured":"Carusi DA . Retained Products of Conception. In: Steinauer J , ed. UpToDate. Waltham, MA, 2017. (accessed 24 Feb 2017)."},{"key":"2025082805170060000_2017.jul14_2.bcr-2017-220452.4","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1097\/AOG.0000000000000795","article-title":"Treating spontaneous and induced septic abortions","volume":"125","author":"Eschenbach","year":"2015","journal-title":"Obstet Gynecol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-220452","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:17:08Z","timestamp":1756383428000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-220452"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7,14]]},"references-count":4,"alternative-id":["10.1136\/bcr-2017-220452"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-220452","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7,14]]}}}