North American Registry of Midwives (NARM) Practice Exam

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What condition might shoulder pain indicate during early pregnancy?

  1. Normal pregnancy discomfort

  2. Ruptured tubal pregnancy

  3. Fibroids in the uterus

  4. Ectopic pregnancy

The correct answer is: Ruptured tubal pregnancy

Shoulder pain during early pregnancy can be an important symptom that may indicate a ruptured tubal pregnancy, also known as an ectopic pregnancy. When an ectopic pregnancy occurs, especially if the fallopian tube ruptures, it can lead to internal bleeding that irritates the diaphragm. This irritation can manifest as referred pain in the shoulder due to the shared nerve pathways. Recognizing that shoulder pain alongside other symptoms may point toward a potentially serious condition, such as a ruptured tubal pregnancy, is vital in the context of early pregnancy complications. It highlights the need for prompt medical evaluation to assess the pregnancy's status and the woman's safety. Understanding the potential implications of shoulder pain can guide healthcare providers in making informed decisions regarding diagnosis and management.