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SGD PROTOCOL
Abortion
PGH LU 7 Interns
Block y
Patient information
Patient is E. A., a 39 y.o. female from Bougainvillea St. Lower Bicutan, Taguig. The
patient was seen at the OB admitting section last 07/10/09 with the chief complaint of
VAGINAL BLEEDING.
History of Present illness
13 days PTC: The patient developed profuse vaginal bleeding, about 2 diapers per day,
with passing of meaty material lasting for four days. Bleeding continued until about 10 days
PTC, the bleeding decreased in amount.
7 days PTC: The patient sought consult at a private MD. TV Ultrasound was done with
the following findings:
The uterus is regularly enlarged measuring 9.8x5.6x7.0 cm. It is anteverted in
position with smooth contour. The myometrial echopattern is homogenous. There are no focal
masses noted. It contains a single gestational sac with irregular borders and mean diameter of
3.3 cm, corresponding to 8 weeks age of gestation. There is no note of an embryo. Cervical
canal is closed.
Both adnexae are clear.
Negative for free pelvic fluid.
Impression: To consider blighted ovum.
The patient was advised to seek consult at PGH due to financial constraints.
Course in PGH
3 days PTC: The patient sought consult at the OB admitting section. BP was 110/70, HR
of 80, RR of 20 and Temp of 37.2 with essentially normal systemic PE findings. IE revealed
normal external genitalia with smooth parous vagina, closed cervix, corpus 8-10 weeks AOG
with no adnexal masses nor tenderness. Their assessment was missed abortion. At this time the
patient still manifested with vaginal bleeding amounting to 3 pads per day. TV utz was done.
The unofficial result was:
The uterus is anteverted with smooth and homogenous echopattern measuring
9.8 x 6.9 x 5.8 cm. The cervix measures 2.7 x 2.1 x 3.1 cm. There is a single irregular GS
measuring 2.6x 29 x 7 cm with no embryo or yolk sac seen. (MSD =2.5=7 2/7 weeks)
The Right Ovary measures 2.3 x 1.7 x 1.6 with CL 1.3 cm
The Left Ovary measures 2.2 x 1.8 x 1.1 cm
There is no free fluid in the cul-de-sac
Impression: Anembryonic pregnancy 7 2/7 weeks AOG by MSD. Normal ovaries with CL
in the right. PCL.
The patient was given Eveprim 1 capsule TID and HNBB 1 cap TID. The patient was then
sent home with advice to increase oral fluid intake and to come back to the OB admitting
section once with profuse vaginal bleeding. The patient was also advised to follow-up after 3
days.
SGD PROTOCOL
Abortion
PGH LU 7 Interns
Block y
Menstrual History
Menarche was at 14-15 years old with regular menstrual interval, lasting for 7 days,
consuming 3 pads per day, usually with associated dysmenorrhea.
LNMP: 12/27/08
Estimated fetal age: 27 3/7 by LMP, 8 weeks by UTZ
Obstetrical History
G8 P7 (7007)
G
YEAR AOG
1
2
3
4
5
6
7
8
1990
1991
1994
1996
1998
2000
2003
2009
Manner
delivery
FT
SVD
FT
SVD
FT
SVD
FT
SVD
FT
SVD
FT
SVD
FT
SVD
Current pregnancy
of Place/ By
Home/hilot
EAMC/ OB
EAMC/ OB
EAMC/ OB
Home/hilot
EAMC/ OB
Home/hilot
Sex
F
F
F
M
F
F
F
Complications
Status
(-) FMC
(-) FMC
(-) FMC
(-) FMC
(-) FMC
(-) FMC
(-) FMC
Alive
Alive
Alive
Alive
Alive
Alive
Alive
Past Medical History
The patient has had no history of Diabetes, Hypertension, Asthma, Goiter, TB. There is
no history of previous obstetrical and gynecological problems, hospitalization or surgical
procedures.
Family Medical History
The patient has no family history of Diabetes, Hypertension, Asthma, Goiter, TB.
Personal/Social History
The patient is an unemployed 2 year course College graduate with no vices. Her first
coitus was at 21 with 1 non-promiscuous sexual partner. No history of STD, and use of OCP’s or
IUD’s.
Current consult
The patient is now presenting in the OB admitting section with BP of 90/60, HR of 90,
RR of 18 and Temp of 37.6 with essentially normal PE findings. IE reveals NEG, smooth and
parous vagina, Corpus enlarged to 10-12 weeks AOG, with no adnexal masses nor tenderness.
Fornices were smooth with no appreciated masses.
SGD PROTOCOL
Abortion
PGH LU 7 Interns
Block y
Guide questions
What are the pertinent points in the history and physical examination? What is a blighted
ovum?
What is your initial impression?
Define abortion. What are the different types of abortion?
What are the possible differentials and why are they considered/ruled out?
What are the possible causes of abortion? What are the risk factors of our patient?
How will you manage this patient?
What diagnostic examinations were done? Why are they ordered?
What medications were given? Why are they prescribed?
Is there a need for a surgical procedure?
How will you advise the patient? When will ovulation resume?