department of obstetrics and gynecology final ppt
TRANSCRIPT
Case Case PresentationPresentation
Clerk Julius Jay S. EstacioClerk Julius Jay S. Estacio
Consultant Adviser: Dr. Janice Consultant Adviser: Dr. Janice Bernal-LacunaBernal-Lacuna
General DataGeneral Data
J.C.J.C. 21 year old21 year old G1P0G1P0 SingleSingle FilipinoFilipino CatholicCatholic
Chief ComplaintChief Complaint
Vaginal bleedingVaginal bleeding
PAST MEDICAL PAST MEDICAL HISTORYHISTORY
No history of hypertensionNo history of hypertension No history of diabetes mellitusNo history of diabetes mellitus No history of heart disease No history of heart disease No asthmaNo asthma No known allergies to food or No known allergies to food or
medicationmedication No previous operationsNo previous operations
FAMILY MEDICAL FAMILY MEDICAL HISTORYHISTORY
Asthma - maternal side Asthma - maternal side No other known heredofamilial No other known heredofamilial
diseasesdiseases
PERSONAL AND SOCIAL PERSONAL AND SOCIAL HISTORYHISTORY
UnemployedUnemployed Co-habitating for 5 months with Co-habitating for 5 months with
a 21 year-old paintera 21 year-old painter Non-smokerNon-smoker Non-alcoholic beverage drinkerNon-alcoholic beverage drinker First coitus: 18 years old, 1 First coitus: 18 years old, 1
sexual partnersexual partner
MENSTRUAL HISTORYMENSTRUAL HISTORY
Menarche: 14 years oldMenarche: 14 years old Subsequent menstrual period: Subsequent menstrual period:
regularly at 28-day intervalregularly at 28-day interval Lasting for 4 - 7 daysLasting for 4 - 7 days Consuming 1 - 2 pads per day, Consuming 1 - 2 pads per day,
fully soakedfully soaked No dysmenorrheaNo dysmenorrhea
GYNECOLOGIC HISTORYGYNECOLOGIC HISTORY
No history of dyspareuniaNo history of dyspareunia No post coital bleeding No post coital bleeding No leucorrheaNo leucorrhea No history of any form of No history of any form of
contraceptioncontraception
OBSTETRICAL HISTORYOBSTETRICAL HISTORY
LNMP: January 19, 2009 LNMP: January 19, 2009 PMP: December 21, 2008 PMP: December 21, 2008 AOG: 10 weeks and 3 daysAOG: 10 weeks and 3 days G1P0G1P0
G1 – present pregnancyG1 – present pregnancy
HISTORY OF PRESENT HISTORY OF PRESENT PREGNANCYPREGNANCY
No prenatal check upsNo prenatal check ups Pregnancy test positive at 6Pregnancy test positive at 6thth week week
AOGAOG Denied taking any medications Denied taking any medications
HISTORY OF PRESENT HISTORY OF PRESENT PREGNANCYPREGNANCY
1 week prior to admission1 week prior to admission Vaginal spottingVaginal spotting No hypogastric painNo hypogastric pain No other signs and symptomsNo other signs and symptoms
HISTORY OF PRESENT HISTORY OF PRESENT PREGNANCYPREGNANCY
Few hours PTAFew hours PTA Increase in vaginal bleeding, soaking 2 Increase in vaginal bleeding, soaking 2
pads per daypads per day passage of meaty materialspassage of meaty materials severe, crampy hypogastric pain, 8/10 severe, crampy hypogastric pain, 8/10
in intensityin intensity Persistence prompted --- consult Persistence prompted --- consult AdmittedAdmitted
PHYSICAL PHYSICAL EXAMINATIONEXAMINATION
General Survey:General Survey: ConsciousConscious CoherentCoherent Ambulatory Ambulatory Not in cardiopulmonary distressNot in cardiopulmonary distress
PHYSICAL PHYSICAL EXAMINATIONEXAMINATION
Vital SignsVital Signs BP=100/70 mmHgBP=100/70 mmHg PR=92 bpmPR=92 bpm RR=18 cpmRR=18 cpm Temp=36.5 Temp=36.5 ººCC Ht=5’1” or 154.94 cms.Ht=5’1” or 154.94 cms. Wt=110 lbs. or 50 kgs.Wt=110 lbs. or 50 kgs.
PHYSICAL PHYSICAL EXAMINATIONEXAMINATION
SkinSkin Good skin turgorGood skin turgor Warm to touchWarm to touch No pallorNo pallor No jaundiceNo jaundice
PHYSICAL PHYSICAL EXAMINATIONEXAMINATION
HEENT:HEENT: pink palpebral conjunctivaepink palpebral conjunctivae anicteric scleraanicteric sclera no cervicolymphadenopathiesno cervicolymphadenopathies
PHYSICAL PHYSICAL EXAMINATIONEXAMINATION
Chest and Lung:Chest and Lung: Symmetrical chest expansionSymmetrical chest expansion no retractionsno retractions clear breath soundsclear breath sounds
PHYSICAL PHYSICAL EXAMINATIONEXAMINATION
CVS:CVS: Adynamic precordiumAdynamic precordium normal ratenormal rate regular rhythmregular rhythm no murmursno murmurs
PHYSICAL PHYSICAL EXAMINATIONEXAMINATION
Abdomen:Abdomen: FlatFlat Normoactive bowel sounds Normoactive bowel sounds TympaniticTympanitic SoftSoft No tendernessNo tenderness
PHYSICAL PHYSICAL EXAMINATIONEXAMINATION
Pelvic ExaminationPelvic Examination:: Inspection Inspection
Normal external genitalia with fair Normal external genitalia with fair hair distributionhair distribution
No massesNo masses No lesionsNo lesions No dischargeNo discharge
PHYSICAL PHYSICAL EXAMINATIONEXAMINATION
Pelvic ExaminationPelvic Examination::Speculum ExaminationSpeculum Examination
Cervix is pink, smooth, no Cervix is pink, smooth, no erosions, with meaty material erosions, with meaty material within the oswithin the os
PHYSICAL PHYSICAL EXAMINATIONEXAMINATION
Pelvic ExaminationPelvic Examination:: Internal ExaminationInternal Examination
Vagina admits 2 fingers with easeVagina admits 2 fingers with ease Cervix openCervix open Uterus enlarged to 8 weeksUterus enlarged to 8 weeks No adnexal masses and tendernessNo adnexal masses and tenderness
PHYSICAL PHYSICAL EXAMINATIONEXAMINATION
ExtremitiesExtremitiesFull and equal peripheral Full and equal peripheral
pulsespulsesno edemano edema
IMPRESSIONIMPRESSION
Incomplete abortion, 10 weeks Incomplete abortion, 10 weeks and 3 days, spontaneous, non-and 3 days, spontaneous, non-
septic, G1P0septic, G1P0
SALIENT FEATURESSALIENT FEATURES
HistoryHistory Positive Positive
pregnancy testpregnancy test Vaginal bleedingVaginal bleeding Hypogastric painHypogastric pain Passage of Passage of
meaty materialmeaty material
Physical Physical ExaminationExamination afebrileafebrile Presence of meaty Presence of meaty
material plugging material plugging cervical oscervical os
Open cervixOpen cervix Uterus enlarged Uterus enlarged
to 8 weeksto 8 weeks
DIFFERENTIAL DIFFERENTIAL DIAGNOSISDIAGNOSIS
Ectopic pregnancyEctopic pregnancy Complete abortionComplete abortion Threatened abortionThreatened abortion
Ectopic PregnancyEctopic Pregnancy
Rule in:Rule in: Positive Positive
pregnancy testpregnancy test Abdominal painAbdominal pain Abnormal Abnormal
vaginal bleedingvaginal bleeding
Rule OutRule Out:: No adnexal mass No adnexal mass
and tenderness and tenderness appreciatedappreciated
No wriggling No wriggling tenderness of cervixtenderness of cervix
Uterus was Uterus was enlarged to 8 weeksenlarged to 8 weeks
Cervix was open Cervix was open with placental-like with placental-like tissue within the ostissue within the os
Complete AbortionComplete Abortion
Rule in:Rule in: Positive Positive
pregnancypregnancy Vaginal bleedingVaginal bleeding Abdominal pain Abdominal pain
or crampsor cramps
Rule OutRule Out:: Uterus was Uterus was
enlarged to 8 enlarged to 8 weeksweeks
Presence of Presence of meaty material meaty material plugging the osplugging the os
Cervix was openCervix was open
Threatened AbortionThreatened Abortion
Rule in:Rule in: Positive Positive
pregnancy testpregnancy test Vaginal bleedingVaginal bleeding Hypogastric painHypogastric pain
Rule Out:Rule Out: Cervix was openCervix was open Uterus was Uterus was
incompatible incompatible with the age of with the age of gestationgestation
Presence of Presence of meaty material meaty material plugging the osplugging the os
PLAN AND PLAN AND MANAGEMENTMANAGEMENT
Completion curettageCompletion curettage
DISCUSSIONDISCUSSION
ABORTIONABORTION
pregnancy termination prior to pregnancy termination prior to 20 weeks gestation or less than 20 weeks gestation or less than 500g birthweight500g birthweight Spontaneous – abortion without Spontaneous – abortion without
medical or mechanical meansmedical or mechanical means Induced – medical or surgical Induced – medical or surgical
meansmeans
ABORTIONABORTION
PathologyPathology:: Hemorrhage in the decidua basalis Hemorrhage in the decidua basalis
followed by necrosis of tissues followed by necrosis of tissues beside the bleedingbeside the bleeding
Ovum detaches which stimulates Ovum detaches which stimulates uterine contractions resulting in uterine contractions resulting in expulsionexpulsion
ABORTIONABORTION
Early abortionEarly abortion 1st trimester or 1st 12 weeks1st trimester or 1st 12 weeks 50% secondary to chromosomal 50% secondary to chromosomal
abnormalitiesabnormalities death of fetus usually precedes death of fetus usually precedes
expulsionexpulsion
ABORTIONABORTION
Late abortionLate abortion 13 weeks to 20 weeks13 weeks to 20 weeks other etiologies (other etiologies (infection, endocrine infection, endocrine
abnormalities, drug use and nutritional abnormalities, drug use and nutritional status)status)
fetus usually alive before fetus usually alive before expulsionexpulsion
PLAN/MANAGEMENT PLAN/MANAGEMENT
Laboratory work-ups for abortion Laboratory work-ups for abortion includeinclude complete blood count with differentialcomplete blood count with differential blood type and Rh factorblood type and Rh factor qualitative and quantitative human qualitative and quantitative human
chorionic gonadotropin-beta chorionic gonadotropin-beta Ultrasound Ultrasound
TREATMENTTREATMENT
Treatment goalTreatment goal::evacuation of the uterus to evacuation of the uterus to
prevent complications such as prevent complications such as further hemorrhage and/or further hemorrhage and/or infectioninfection
Completion CurettageCompletion Curettage
THANK YOU.THANK YOU.GOD BLESS US ALWAYS.GOD BLESS US ALWAYS.