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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?