tailieunhanh - Phương pháp điều trị sản khoa - Tình huống số 1

Tài liệu tham khảo dành cho giáo viên, sinh viên chuyên ngành y khoa chuyên khoa sản - Các tình huống, trường hợp bệnh phụ khoa, sản khoa và cách giải quyết. | CASE 10 A 35-year-old woman at 8 weeks gestation complains of crampy lower abdominal pain and vaginal bleeding. She states that the pain was intense last night and that something that looked like liver passed per vagina. Alter that the pain subsided tremendously as did the vaginal bleeding. On examination her BP is 130 80 HR 90 min and temperature is 98 E Her abdominal examination is unremarkable. The pelvic examination reveals normal external female genitalia. The cervix is closed and nontender and no adnexal masses are appreciated. What is the most likely diagnosis What is the your next step in management 96 case FILES OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 10 Completed Spontaneous Abortion Summary A 35-year-old woman at 8 weeks gestational age had intense crampy lower abdominal pain and vaginal bleeding last night after passing what looked like liver her pain and bleeding subsided tremendously. On examination her cervix is closed. Most likely diagnosis Completed abortion. Next step in management Follow hCG levels to zero. Analysis Objectives 1. Know the typical characteristics of the different types of spontaneous abortions. 2. Understand the clinical presentations of and the treatments for the different types of abortions. Considerations This woman is pregnant at 8 weeks gestation which is in the first trimester. She noted intense cramping pain the night before and passed something that looked like liver to her. This may be tissue although the gross appearance of presumed tissue can be misleading. The patient s pain and bleeding have subsided since the passage of the liver. This fits with the complete expulsion of the pregnancy tissue. The clinical picture of passage of tissue resolution of cramping and bleeding and a closed cervical OS are consistent with a completed abortion. To confirm that all of the pregnancy trophoblastic tissue has been expelled from the uterus the clinician should follow serum quantitative hCG levels. It is expected that the hCG .