incomplete abortion Flashcards
task
Your patient is a 39-year-old woman who has been married for 12 months and suffered a spontaneous abortion at
eight weeks of gestation six months ago. This was her only previous pregnancy.
An ambulance has brought her to the hospital today because of severe lower abdominal pain and heavy vaginal
bleeding for the last 12 hours. Her last period was nine weeks ago. You are seeing her in the Emergency Department
at the local hospital
YOUR TASKS ARE TO:
* Take any further relevant history you require (it should not take you more than 3-4 minutes to do this).
* Ask the examiner for the appropriate findings you would look for on general and gynaecological examination,
and then ask for any investigation results you feel are necessary to enable you to make a diagnosis.
* Advise the patient, in lay terms, of the diagnosis and the subsequent management required
questions
-have you been trying to conceive? yes no contraception
-menstrual hx : regular, 4wk, 5 days
-how long the bleed and pain?
-describe the pain?site, radiation no, intermittent
-bleed : pads, any clots , tissue
-dizziness
-blood group
general exam
1.General appearance: She Is clammy, pale, obviously distressed and in pain.
Cardiovascular: Pulse 90/min
Blood pressure 80/50 mmHg
2.Abdominal examination: Lax, non-tender. No mass or viscus palpable.
3.Speculum examination: Cervix open, products of conception (POC) in cervical os.
(If the candidate does not ask if the cervix is open or
closed, don’t give this information but comment on
uterine size alone).
4.Pelvic examination: The uterus is enlarged to the size of an eight week
pregnancy, anteverted and mobile. Cervical os is open and easily admits
one finger. Products of contraception are felt in the cervix. No adnexal
masses or tenderness.
4.Investigation results (Give these results if the specific test is requested):
Blood group O Rh negative, indirect Coombs test negative.
Hb 112 g/L.
mx
-diagnosed with Incomlete abortion
-RPOC should be removed immediately to treat shock and reduce bleeding.
-IV access: iv fluid, blood cross-matching
-give ergometrine or oxytocin to dec blood
-give anti D
-Curretage : ASAP, curretings sent for histology
-if BP<110 after curreting>more IV fluids
explanation
-most likely due to chromosomal abnormality
-increase due advance maternal age
-25-30 percent likelihood of miscarriage next time she gets pregnant
-Next pregnancy :
USS 7 weeks
maternal screening
nuchal fold thickness 11-12 weeks
if all well >chorionic villous sample, amniocentesis
