1
ACUTE DETERIORATION: A CLIENT-FOCUSED CASE STUDY
Institutional Affiliation
Student Name
Supervisor Name
, 2
1. Case Introduction and Justification
The case study focuses on the acute degradation of Ms Aisha Khan (pseudonym), who
was admitted with a ruptured ectopic pregnancy and complicated by sepsis. She presented
with sudden pain in the lower abdomen to the right and upper to the shoulder, hypotension,
tachycardia, and fever. The ultrasound and positive pregnancy test showed a ruptured right
tubal ectopic pregnancy with massive haemoperitoneum (Adrien et al., 2025). Her quick
deterioration was a life-threatening obstetric crisis that needed to be identified and addressed
by a multidisciplinary approach. This situation is common, especially in low-resource and
rural areas, where maternal morbidity and mortality are often caused by delays in diagnosis
and transfer (Ssegujja et al., 2025).
The choice of this case can be explained by the fact that it provides an opportunity to
emphasise the role of inequities in healthcare access, socioeconomic differences, and poor
resource allocation in the reproductive health outcomes of women. Most women face
difficulties accessing emergency obstetric services due to long distances to facilities, limited
diagnostic capabilities, and understaffing (Alemayehu et al., 2022). These structural
disparities often lead to presentation lag, and this is also the case with Ms Khan, as the lapse
in referral to a low-level facility contributed to her haemodynamic decline (Sibanda, 2022).
The World Health Organisation (2023) says that ectopic pregnancy is still a leading cause of
maternal deaths that can be prevented in women, which is a manifestation of systemic
failures in fair healthcare delivery.
The case facilitates a critical analysis of clinical rationality, ethical decision-making,
and multidisciplinary cooperation within a devolved healthcare system. By relying on
Hundial (2020) model of clinical reasoning and existing evidence-based guidelines, the
research determines how medical workers can reconcile life-saving actions with their
compassionate, inclusive, and patient-focused care within the confines of the system.
, 3
2. Clinical Background and Pathophysiological Analysis
Ms Aisha Khan is a 27-year-old woman with complaints of acute right lower
abdomen pain that radiated to the tip of her shoulder, with a history of light vaginal bleeding
and high-grade fever. Her medical history showed iron-deficiency anaemia of mild levels and
a copper intrauterine device (IUD) that was placed two years ago. Prior to referral, she was
treated in a Level 3 health centre, where she was treated on a symptomatic basis and assumed
to have had inflammatory disease of the pelvis because of a lack of diagnostic imaging (Taira
et al., 2022). The missed diagnosis was a result of a delay in referral and the inability to carry
out an ultrasound, which resulted in haemodynamic instability and collapse on arrival at the
referral hospital (Kwok et al., 2022).
Pathophysiologically, an ectopic pregnancy is one in which a fertilised ovum implants
outside the uterine cavity, most commonly within the fallopian tube (Zhang et al., 2024). The
tubal implantation impairs the blood vessels of the fallopian wall, and as the trophoblastic
tissue infiltrates, it ruptures, causing severe intraperitoneal bleeding, which causes the
subsequent hypovolaemic shock (Yakubovich, 2023). The disruption causes the spillage of
blood and necrotic tissue into the peritoneal cavity, initiating a systemic inflammatory
response (Shen et al., 2022). Ms Khan's increase in the level of white blood cells (21.4
x109/L), C-reactive protein (240 mg/L), and lactate (4.5 mmol/L) showed that Khan
experienced sepsis concurrently, or dysregulated host response to infection. The sepsis was
caused by bacterial contamination of the peritoneal cavity resulting from tissue necrosis and
blood stagnation (Clements et al., 2021).
Healthcare systems are organized in a tiered hierarchy, but rural and remote areas are
underserved due to the uneven distribution of diagnostic equipment and trained staff
(Alemayehu et al., 2022). In the case of Ms Khan, the three delays model, which consists of
delays in deciding to pursue care, delays until one reaches a facility, and delays until one is
ACUTE DETERIORATION: A CLIENT-FOCUSED CASE STUDY
Institutional Affiliation
Student Name
Supervisor Name
, 2
1. Case Introduction and Justification
The case study focuses on the acute degradation of Ms Aisha Khan (pseudonym), who
was admitted with a ruptured ectopic pregnancy and complicated by sepsis. She presented
with sudden pain in the lower abdomen to the right and upper to the shoulder, hypotension,
tachycardia, and fever. The ultrasound and positive pregnancy test showed a ruptured right
tubal ectopic pregnancy with massive haemoperitoneum (Adrien et al., 2025). Her quick
deterioration was a life-threatening obstetric crisis that needed to be identified and addressed
by a multidisciplinary approach. This situation is common, especially in low-resource and
rural areas, where maternal morbidity and mortality are often caused by delays in diagnosis
and transfer (Ssegujja et al., 2025).
The choice of this case can be explained by the fact that it provides an opportunity to
emphasise the role of inequities in healthcare access, socioeconomic differences, and poor
resource allocation in the reproductive health outcomes of women. Most women face
difficulties accessing emergency obstetric services due to long distances to facilities, limited
diagnostic capabilities, and understaffing (Alemayehu et al., 2022). These structural
disparities often lead to presentation lag, and this is also the case with Ms Khan, as the lapse
in referral to a low-level facility contributed to her haemodynamic decline (Sibanda, 2022).
The World Health Organisation (2023) says that ectopic pregnancy is still a leading cause of
maternal deaths that can be prevented in women, which is a manifestation of systemic
failures in fair healthcare delivery.
The case facilitates a critical analysis of clinical rationality, ethical decision-making,
and multidisciplinary cooperation within a devolved healthcare system. By relying on
Hundial (2020) model of clinical reasoning and existing evidence-based guidelines, the
research determines how medical workers can reconcile life-saving actions with their
compassionate, inclusive, and patient-focused care within the confines of the system.
, 3
2. Clinical Background and Pathophysiological Analysis
Ms Aisha Khan is a 27-year-old woman with complaints of acute right lower
abdomen pain that radiated to the tip of her shoulder, with a history of light vaginal bleeding
and high-grade fever. Her medical history showed iron-deficiency anaemia of mild levels and
a copper intrauterine device (IUD) that was placed two years ago. Prior to referral, she was
treated in a Level 3 health centre, where she was treated on a symptomatic basis and assumed
to have had inflammatory disease of the pelvis because of a lack of diagnostic imaging (Taira
et al., 2022). The missed diagnosis was a result of a delay in referral and the inability to carry
out an ultrasound, which resulted in haemodynamic instability and collapse on arrival at the
referral hospital (Kwok et al., 2022).
Pathophysiologically, an ectopic pregnancy is one in which a fertilised ovum implants
outside the uterine cavity, most commonly within the fallopian tube (Zhang et al., 2024). The
tubal implantation impairs the blood vessels of the fallopian wall, and as the trophoblastic
tissue infiltrates, it ruptures, causing severe intraperitoneal bleeding, which causes the
subsequent hypovolaemic shock (Yakubovich, 2023). The disruption causes the spillage of
blood and necrotic tissue into the peritoneal cavity, initiating a systemic inflammatory
response (Shen et al., 2022). Ms Khan's increase in the level of white blood cells (21.4
x109/L), C-reactive protein (240 mg/L), and lactate (4.5 mmol/L) showed that Khan
experienced sepsis concurrently, or dysregulated host response to infection. The sepsis was
caused by bacterial contamination of the peritoneal cavity resulting from tissue necrosis and
blood stagnation (Clements et al., 2021).
Healthcare systems are organized in a tiered hierarchy, but rural and remote areas are
underserved due to the uneven distribution of diagnostic equipment and trained staff
(Alemayehu et al., 2022). In the case of Ms Khan, the three delays model, which consists of
delays in deciding to pursue care, delays until one reaches a facility, and delays until one is
