{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T06:24:12Z","timestamp":1787293452128,"version":"build-2736575974"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ectopic pregnancy (EP) is an obstetric emergency; early diagnosis is critical for maternal survival. In resource-limited settings, such as Ebola treatment units (ETU), delayed diagnosis or management of EP often leads to rupture and life-threatening hemorrhagic shock.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report the case of a pregnant woman in her 30s who was admitted to the ETU with suspected Ebola virus disease in the Democratic Republic of Congo (DRC). Her clinical presentation included fever and abdominal pain, which began 4\u202fdays before her admission. Thirteen months earlier, she had recovered from an Ebola infection. At admission, she presented with 8\u202fweeks of amenorrhea and discrete pelvic pain. On vaginal examination, we noted a slightly enlarged uterus and palpated a small left adnexal mass. Laboratory exams confirmed malaria and pregnancy. Her EVD test was negative. Due to the absence of an ultrasound machine in the ETU, pelvic ultrasound was impossible. Supportive treatment was initiated. Nineteen hours after admission, the patient developed an acute surgical abdomen, with progressive left-sided pelvic pain, abdominal distension, and diffuse tenderness. A ruptured ectopic pregnancy was suspected and confirmed by diagnostic abdominal puncture, which revealed hemoperitoneum. She developed hemorrhagic shock. However, the ETU lacked an operating room, surgical equipment, and anesthetic drugs. Transfer to another ETU was not feasible due to the absence of a surgical-capable facility, while transfer to a community facility required at least a second negative EVD test 48\u202fh after the first. We used an unused building that was part of the neighboring health center to perform an explorative laparotomy, which revealed an EP in the left tube with ampullary dislocation and active bleeding. We performed a left salpingectomy and homeostatic sutures. The real-time polymerase chain reaction (RT-PCR) tests for EVD performed at 48 and 72\u202fh were negative. She had a normal postoperative course and was discharged from ETU to the community on the 14th day after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Ruptured ectopic pregnancy (REP) remains a life-threatening obstetric emergency that may occur in ETUs, where resources and treatment conditions are limited. To protect maternal health, ETUs should ensure not only proper care for Ebola infection but also adequate capacity for the timely diagnosis and management of obstetric complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1848720","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T05:36:01Z","timestamp":1787290561000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Challenges in managing ruptured ectopic pregnancy complicated by hemorrhagic shock in an Ebola treatment unit in DR Congo: first reported case"],"prefix":"10.3389","volume":"13","author":[{"given":"Prince","family":"Imani-Musimwa","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine and School of Public Health, University of Goma","place":["Goma, Democratic Republic of Congo"]},{"name":"Centre de Recherche et d\u2019Evaluation en Sant\u00e9 Globale et Action Humanitaire (CRESAH)","place":["Goma, Democratic Republic of Congo"]},{"name":"Faculty of Medicine and School of Public Health, Evangelical University in Africa","place":["Bukavu, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Grant","sequence":"additional","affiliation":[{"name":"Maternal and Infant Care Center, University of Washington Medical Center","place":["Seattle, WA, United States"]},{"name":"Centre de Recherche et d\u2019Evaluation en Sant\u00e9 Globale et Action Humanitaire (CRESAH)","place":["Goma, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Mukadi-Bamuleka","sequence":"additional","affiliation":[{"name":"Institut National de Recherche Bio-M\u00e9dicale (INRB)","place":["Kinshasa, Democratic Republic of Congo"]},{"name":"Department of Medical Biology, School of Medicine, University of Kinshasa","place":["Kinshasa, Democratic Republic of Congo"]},{"name":"Rodolphe M\u00e9rieux INRB-Goma Loaboratry","place":["Goma, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rigo","family":"Fraterne-Muhayangabo","sequence":"additional","affiliation":[{"name":"Centre de Recherche et d\u2019Evaluation en Sant\u00e9 Globale et Action Humanitaire (CRESAH)","place":["Goma, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Ombeni-Musimwa","sequence":"additional","affiliation":[{"name":"Institut pour la recherche interdisciplinaire en sciences juridiques (JUR-I), Facult\u00e9 de Droit et de Criminologie, Universit\u00e9 Catholique de Louvain","place":["Louvain-la-Neuve, Belgium"]},{"name":"Centre de Recherche et d\u2019Evaluation en Sant\u00e9 Globale et Action Humanitaire (CRESAH)","place":["Goma, Democratic Republic of Congo"]},{"name":"Faculty of Medicine and School of Public Health, Evangelical University in Africa","place":["Bukavu, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zacharie","family":"Tsongo-Kibendelwa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, University of Kisangani","place":["Kisangani, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Nyakio-Ngeleza","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and School of Public Health, Evangelical University in Africa","place":["Bukavu, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Kitenge-Omasumbu","sequence":"additional","affiliation":[{"name":"Minist\u00e8re de la Sant\u00e9 Publique, Hygi\u00e8ne et Prevention","place":["Kinshasa, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Th\u00e9ophile","family":"Barhwamire-Kabesha","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Official University of Bukavu","place":["Bukavu, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieudonn\u00e9","family":"Sengey-Mushengezi-Amani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, University of Kinshasa","place":["Kinshasa, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Placide","family":"Mbala-Kingebeni","sequence":"additional","affiliation":[{"name":"Department of Medical Biology, School of Medicine, University of Kinshasa","place":["Kinshasa, Democratic Republic of Congo"]},{"name":"Institut pour la recherche interdisciplinaire en sciences juridiques (JUR-I), Facult\u00e9 de Droit et de Criminologie, Universit\u00e9 Catholique de Louvain","place":["Louvain-la-Neuve, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Bitwe-Mihanda","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neonatology, School of Medicine, University of Goma","place":["Goma, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juakali","family":"Sihali-Kyolov","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, University of Kisangani","place":["Kisangani, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mija","family":"Ververs","sequence":"additional","affiliation":[{"name":"Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health","place":["Baltimore, MD, United 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