Case Presentation

Clerk Julius Jay S. Estacio

Consultant Adviser: Dr. Janice Bernal-
Lacuna
 General Data
 J.C.
 21 year old
 G1P0
 Single
 Filipino
 Catholic
Chief Complaint

Vaginal bleeding
 PAST MEDICAL HISTORY
 No history of hypertension
 No history of diabetes mellitus
 No history of heart disease
 No asthma
 No known allergies to food or medication
 No previous operations
FAMILY MEDICAL HISTORY
 Asthma - maternal side
 No other known heredofamilial diseases
 PERSONAL AND SOCIAL
HISTORY
 Unemployed
 Co-habitating for 5 months with a 21
year-old painter
 Non-smoker
 Non-alcoholic beverage drinker
 First coitus: 18 years old, 1 sexual partner
 MENSTRUAL HISTORY
 Menarche: 14 years old
 Subsequent menstrual period: regularly at
28-day interval
 Lasting for 4 - 7 days

 Consuming 1 - 2 pads per day, fully

soaked
 No dysmenorrhea
 GYNECOLOGIC HISTORY
 No history of dyspareunia
 No post coital bleeding
 No leucorrhea
 No history of any form of contraception
 OBSTETRICAL HISTORY
 LNMP: January 19, 2009
 PMP: December 21, 2008
 AOG: 10 weeks and 3 days
 G1P0
G1 – present pregnancy
 HISTORY OF PRESENT
PREGNANCY
 No prenatal check ups
 Pregnancy test positive at 6th week AOG
 Denied taking any medications
 HISTORY OF PRESENT
PREGNANCY
 1 week prior to admission
 Vaginal spotting
 No hypogastric pain
 No other signs and symptoms
 HISTORY OF PRESENT
PREGNANCY
 Few hours PTA
 Increase in vaginal bleeding, soaking 2 pads per
day
 passage of meaty materials

 severe, crampy hypogastric pain, 8/10 in intensity

 Persistence prompted --- consult

 Admitted
 PHYSICAL EXAMINATION
 General Survey:
 Conscious
 Coherent

 Ambulatory

 Not in cardiopulmonary distress

 PHYSICAL EXAMINATION
 Vital Signs
 BP=100/70 mmHg
 PR=92 bpm

 RR=18 cpm

 Temp=36.5 ºC

 Ht=5’1” or 154.94 cms.

 Wt=110 lbs. or 50 kgs.

 PHYSICAL EXAMINATION
 Skin
 Good skin turgor

 Warm to touch

 No pallor
 No jaundice
 PHYSICAL EXAMINATION
 HEENT:
 pink palpebral conjunctivae

 anictericsclera
 no cervicolymphadenopathies
 PHYSICAL EXAMINATION
 Chest and Lung:
 Symmetrical chest expansion

 no retractions

 clear breath sounds

 PHYSICAL EXAMINATION
 CVS:
 Adynamic precordium

 normal rate

 regular rhythm

 no murmurs
 PHYSICAL EXAMINATION
 Abdomen:
 Flat

 Normoactive bowel sounds

 Tympanitic

 Soft

 No tenderness
 PHYSICAL EXAMINATION
 Pelvic Examination:
 Inspection
 Normal external genitalia with fair hair
distribution
 No masses

 No lesions

 No discharge
 PHYSICAL EXAMINATION
 Pelvic Examination:
 Speculum Examination
 Cervix is pink, smooth, no erosions, with
meaty material within the os
 PHYSICAL EXAMINATION
 Pelvic Examination:
 Internal Examination
 Vagina admits 2 fingers with ease

 Cervix open

 Uterus enlarged to 8 weeks

 No adnexal masses and tenderness

 PHYSICAL EXAMINATION
 Extremities
 Full and equal peripheral pulses

 no edema
 IMPRESSION

Incomplete abortion, 10 weeks and 3 days,

spontaneous, non-septic, G1P0
 SALIENT FEATURES
 History  Physical
 Positive pregnancy Examination
test  afebrile
 Vaginal bleeding  Presence of meaty
 Hypogastric pain material plugging
 Passage of meaty cervical os
material  Open cervix

 Uterus enlarged to 8
weeks
 DIFFERENTIAL DIAGNOSIS
 Ectopic pregnancy
 Complete abortion
 Threatened abortion
 Ectopic Pregnancy
 Rule in:  Rule Out:
 Positive pregnancy  No adnexal mass and
test tenderness appreciated
 No wriggling
 Abdominal pain
tenderness of cervix
 Abnormal vaginal
 Uterus was enlarged to
bleeding 8 weeks
 Cervix was open with
placental-like tissue
within the os
 Complete Abortion
 Rule in:  Rule Out:
 Positive pregnancy  Uterus was enlarged to 8
weeks
 Vaginal bleeding

 Abdominal pain or
 Presence of meaty
material plugging the
cramps
os
 Cervix was open
 Threatened Abortion
 Rule in:  Rule Out:
 Positive pregnancy  Cervix was open
test  Uterus was
 Vaginal bleeding incompatible with the
 Hypogastric pain age of gestation
 Presence of meaty
material plugging the
os
 PLAN AND MANAGEMENT
 Completion curettage
DISCUSSION
 ABORTION
 pregnancy termination prior to 20 weeks
gestation or less than 500g birthweight
 Spontaneous – abortion without medical or
mechanical means
 Induced – medical or surgical means
 ABORTION
 Pathology:
 Hemorrhage in the decidua basalis followed
by necrosis of tissues beside the bleeding
 Ovum detaches which stimulates uterine
contractions resulting in expulsion
 ABORTION
 Early abortion
 1st trimester or 1st 12 weeks

 50% secondary to chromosomal

abnormalities
 death of fetus usually precedes expulsion
 ABORTION
 Late abortion
 13 weeks to 20 weeks

 other etiologies (infection, endocrine

abnormalities, drug use and nutritional status)
 fetus usually alive before expulsion
 PLAN/MANAGEMENT
 Laboratory work-ups for abortion include
 complete blood count with differential
 blood type and Rh factor

 qualitative and quantitative human chorionic

gonadotropin-beta
 Ultrasound
 TREATMENT
 Treatment goal:
 evacuation of the uterus to prevent
complications such as further
hemorrhage and/or infection
 Completion Curettage
 THANK YOU.
GOD BLESS US ALWAYS.