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CASE PRESENTATION
General Data:
A.M., 30 years old, G5P4004, LMP: July
25,2006, PMP: June 25, 2006, AOG: 9 4/7
weeks, EDC: April 30,2007 admitted for
the first time at Sacred Heart Hospital due
to vaginal bleeding.
Chief Complaint:
Vaginal Bleeding
History of Present Illness (HPI):
Unremarkable
Review of Systems:
Skin- no jaundice, no pallor, no rashes, no
pruritus, no bruising
HEENT- no migraine, no history of head
trauma, no visual disturbances, no
abnormal lacrimation, no difficulty of
hearing, no epistaxis, no sinusitis, no nasal
discharges, no gum bleeding, no mouth
sores, no tongue sores, no hoarseness.
Neck- no history of lumps and masses, no
stiffness.
Breast- no history of trauma, no lumps, no
discharges.
Respiratory system- no shortness of
breath, no chronic cough, no hemoptysis,
no wheezing.
Cardiovascular system- no chest pain, no
palpitations, no edema, no dizziness.
Gastrointestinal tract- no change in
bowel habits, no mass.
Urinary tract- no dysuria, no urgency
Genitalia- vaginal bleeding noted 10 days
PTA, no dyspareunia, no post-coital
bleeding, no pruritus.
Nervous system- no paralysis, no
disturbances in smell or vision, no history
of loss of consciousness.
Metabolic- no weight loss, no weight
gain, no fever.
Psychiatric- no nervousness, no
memory loss, no hallucinations, no
insomnia.
Menstrual history:
= 1740 kcal
BMI= 55 / (1.52)2 = 24 kg / m2
She has no change in appetite, no
dentures, chews food properly,
Has no allergy to food. She does not
have preference to food.
Their budget per meal is P200.00
PHYSICAL EXAMINATION
General Survey:
Examined conscious, coherent,
cooperative, ambulatory, afebrile,
not in respiratory distress and with
the following vital signs:
Submucous Myoma
Ectopic Pregnancy
↓
Retroperitoneal tubal hemorrhage
Tubal rupture
Clinical Characteristics
Incomplete Abortion
Non-septic; non-induced
Abortion
Termination of pregnancy before 20 weeks
based upon the date of the first day of last
normal menses.
The delivery of a fetus-neonate that weighs
less than 500 g.
The fetus and placenta are likely to be
expelled together before 10 weeks, but
separately thereafter. When the placenta, in
whole or in part, is retained in the uterus,
bleeding ensues sooner or later
incomplete abortion.
Incomplete Abortion: Etiology
Genetic
↓
Stimulation of uterine contraction
Expulsion
Clinical Characteristics
Incomplete abortion refers to the passage
of some but not all fetal or placental tissue
from the uterine cavity through the
cervical canal before 20 weeks’ gestation.
Most abortions that occur between 8-14
weeks AOG are incomplete.
If only a portion of the products of
conception have been expelled and the
cervix remains dilated, a diagnosis of
incomplete abortion is made.
In many cases, the retained placental
tissue simply lies loose in the cervical
canal and can be lifted from an exposed
external os with ovum or ring forceps
Hemorrhage from incomplete
abortion is occasionally severe
but rarely fatal
Basis for inclusion
Vaginal bleeding
(+) pregnancy test
18 hours prior to admission, had passage
of meaty tissues
Cervix admits tip
Management
Curettage
– Indicated if missing products of
conception are evident
– It is often unnecessary to dilate the
cervix before curettage
– In many cases, the retained placental
tissue simply lies loose in the cervical
canal and can be lifted form an exposed
os with ovum or ring forceps
Management
A woman with a more advanced pregnancy,
or a woman who is bleeding heavily, should
be hospitalized and the retained tissue
removed without delay.
Fever is not a contraindication to curettage
once appropriate antibiotic treatment has
been started.
COURSE IN THE WARD