Instructions
Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
Discussion
Discuss the questions that would be important to include when interviewing a patient with this issue.
When interviewing an adolescent, some prevention and counseling may include questions about:
- Home
- Education / Employment
- Eating
- Activities
- Drugs
- Sexuality
- Suicide / Depression
- Safety / Violence
Questions I would ask in regard to her vaginal bleeding would include:
When did your last period begin?
How long do your periods last?
What other symptoms do you have with your period? (abdominal pain, headache, bloating, etc.) Is your bleeding irregular in amount or duration?
Do you have bleeding between your menstrual cycles?
Are your breasts tender?
Are you sexually active?
Is it possible that you are pregnant?
Do you have any pelvic pain?
How severe (1-10 scale) is your pelvic pain?
Have you had pelvic inflammatory disease?
Do you have pain with intercourse?
Have you had sex that was painful or rough, or been forced to have sex?
Are you having, or have you had unprotected sex?
Have you had any sexually transmitted disease?
Describe the clinical findings that may be present in a patient with this issue.
Being that this patient’s vaginal bleeding is due to a spontaneous abortion, some of the clinical findings may include vaginal bleeding, abdominal pain, and passage of tissue (Alves, 2020).
Are there any diagnostic studies that should be ordered on this patient? Why?
Along with beta-hCG measurement and ultrasound, a HGB and HCT should be obtained to rule out acute blood loss anemia. Since spontaneous abortion can be precipitated by infection, wet mount examination and screening for gonorrhea and chlamydia should be considered (Alves, 2020).
List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.
Differential Diagnosis
- Ectopic pregnancy– A pregnancy in which the fertilized egg implants outside the uterus. Symptoms include pelvic pain and vaginal bleeding.
- Molar pregnancy- A noncancerous tumor that develops in the uterus as a result of a nonviable pregnancy. The pregnancy may seem normal at first, but when symptoms develop they include dark brown to bright red vaginal bleeding during the first trimester, along with severe nausea and vomiting (Al-Talib, 2016).
- Viable pregnancy with implantation bleeding- When the fertilized egg attaches to the uterine wall, it may cause bleeding that can last 2-3 days
Primary Diagnosis
- Spontaneous Abortion- Spontaneous abortion is the loss of pregnancy naturally before 20 weeks of gestation (Alves, 2020).
Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.
The conventionally accepted regimen for medical management consists of misoprostol 800mcg vaginally, with a repeated dose if needed anytime from 3hrs to 7 days after the first dose. Premedication with mifepristone 200mg PO 24hrs before the first dose of misoprostol may result in a higher success rate. Surgical management consists of D&C as needed (Alves, 2020). Follow up as directed my healthcare professional.
Reference
Al-Talib, A. (2016). Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a tertiary care hospital in Dammam, Saudi Arabia. Journal of Family & Community Medicine 23(3), p. 161-165. doi: 10.4103/2230-8229.189129
Alves, C. (2020). Spontaneous abortion. StatPearls. Retrieved from https://www.statpearls.com/articlelibrary/viewarticle/29399