tailieunhanh - Tình huống sản khoa - Tình huống 8

Tham khảo tài liệu 'tình huống sản khoa - tình huống 8', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 7 An 18-year-old ì 1 PO woman who is pregnant at 7 weeks gestation by last menstrual period complains of a 2-day history of vaginal spotting and lower abdominal pain. She denies a history of sexually transmitted diseases. On examination her BP is 130 60 and HR 70 beats per min and temperature is 99 E Her neck is supple and the heart examination is normal. I he lungs arc clear bilaterally. The abdomen is nontender and no masses are palpated. On pelvic examination the uterus is 4-week size and nontender. There are no adnexal masses on pelvic examination. rhe quantitative bcta-hCG level is 700 mIU mL Third International Standard and a transvaginal ultrasound reveals an empty uterus and no adnexal masses. What is your next step in the management of this patient 74 s I Illis OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 7 Threatened Abortion Sil III lììíirv All 18-year-old woman at 7 weeks gestation by LMP complains of a 2-day history of vaginal spotting and lower abdomen pain. The physical examination reveals a 4-weck sized uterus and unremarkable adnexa. The bcta-hCG level is 700 mIU mL and no intrauterine gestational sac is noted on endovaginal sonography. Next step in management Follow up beta-hCG in 48 hr. Analysis Objectives 1. Understand the concept of the 11CG discriminatory zone or threshold and its utility with transvaginal sonography. 2. Understand the principle of obtaining a follow-up hCG level when a patient is asymptomatic and has an hCG level that is below the discriminatory zone. 3. Know that a normal ultrasound examination does not rule out the presence of an ectopic pregnancy. Considerations This 18-year-old woman complains of lower abdominal pain and vaginal spotting which in a woman of childbearing potential should be considered an ectopic pregnancy until otherwise proven. She does not have a history of sexually transmitted diseases which if present would be a risk factor for an ectopic pregnancy. The physical examination is unremarkable and .