tailieunhanh - Tình huống sản khoa - Tình huống 1

Tham khảo tài liệu 'tình huống sản khoa - tình huống 1', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 30 A 19-ycar-old 62 Ab 1 woman at 7 weeks gestation by LMP complains of vaginal spotting. She denies the passage of tissue per vagina any trauma or recent intercourse. Her past medical history is significant for a pelvic infection approximately 3 yr ago. She had used an oral contraceptive agent 1 yr previously. Her appetite is normal. On examination her BP is 100 60 HR 90 bpm and temp afebrile. The abdomen is nontender with normoactive bowel sounds. On pelvic examination the external genitalia are normal. The cervix is closed and nontender. The uterus is 4 weeks size and no adnexal tenderness is noted. The quantitative beta-hCG is 2300 mIU mL Third International Standard . A transvaginal sonogram reveals an empty uterus and no adnexal masses. What is your next step What is the most likely diagnosis 250 CASE FILES OBSTETRICS AND GYNECOLOGY ANSWERSTO CASE 30 Ectopic Pregnancy Suiììiìiưrv A 19-year-old G2 Ab 1 woman at 7 weeks gestation by LMP has vaginal spotting. Her history is significant for a prior pelvic infection. Her BP is 100 60 HR 90 bpm and her abdomen is nontender. Pelvic examination shows a closed and nontender cervix a uterus of 4 weeks size and no adnexal tenderness. The quantitative beta-hCG is 2300 mlU mL 3rd IS . A transvaginal sonogram reveals an empty uterus and no adnexal masses. Next step Laparoscopy. Most likely diagnosis Ectopic pregnancy. Analysis Objectives 1. Understand that any woman with amenorrhea and vaginal spotting or lower abdominal pain should have a pregnancy test to evaluate the possibility of ectopic pregnancy. 2. Understand the role of the hCG level and the threshold for trans-vaginal sonogram. 3. Know that the lack of clinical or ultrasound signs of ectopic pregnancy does not exclude the disease. Considerations The woman is at 7 weeks gestation by last menstrual period and presents with vaginal spotting. Any woman with amenorrhea and vaginal spotting should have a pregnancy test. The physical examination is normal. Notably