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BATA, BATA PAANO KA

NAWALA?
LABORATORIES
CBC:
WBC 10.0
Neutrophils 75.1 HIGH
Lymphocytes 16.1 LOW
Monocytes 6.4
Eosinophils 2.1
Basophils 0.3
RBC 4.26 LOW
Hemoglobin 121 LOW
Hematocrit 0.372 LOW
MCV 87
MCH 28.4
MCHC 326
RDW 11.7
Platelet Count 253
MPV 9.6

Blood type: O Rh +
SALIENT FEATURES
Gen. Data:
43 Y/O
G4P3(3003)
5 6/7 AOG
Chief complaint:
vaginal bleeding
History:
Cessation of menses: May 23, 2017
(+)Pregnancy test
(+) UTI (1st trimester: May 26,2017, unrecalled medications)
signs and symptoms started as: (+) hypogastric pain and vaginal spotting which
became (+) vaginal bleeding, with passage of meaty materials
P.E:
Cervix soft, uterus unenlarged (-) adnexal mass,(-) tenderness,(+) minimal vaginal
bleeding, placental tissues plugging the os
Diagnostics/Ancillaries:

TVS: 6/21
IMPRESSION:
o Consider early intrauterine pregnancy of about 5 weeks and 6 days AOG.
Suggest clinical correlation.
o (EDC: 02/15/2017)
o Normal ovaries
TVS 7/3
IMPRESSION:
o Normal sized retroverted uterus with thickened endometrium as described.
o Suggestive of retained products of conception
o Normal ovaries with corpus luteum in the left ovary
DIFFERENTIAL DIAGNOSIS
1. ECTOPIC PREGNANCY
2. GESTATIONAL TROPHOBLASTIC DISEASE
3. ABORTION
Differentials Rule In Rule Out
ECTOPIC PREGNANCY -one of the possible reasons for 1st Patient:
trimester bleeding (-) prior history of ectopic pregnancy
Patient: Surgeries for a prior tubal pregnancy, for
(+) abdominal pain fertility restoration, or for sterilization, STDs
(+)amenorrhea PE:
(+)minimal vaginal bleeding (-)adnexal mass

TVS: (6/21/2017)
(+) gestational sac
IMPRESSION:
Consider early intrauterine pregnancy
of about 5 weeks and 6 days AOG.
Suggest clinical correlation.
(EDC: 02/15/2017)
Normal ovaries

Others: No noted fullness of retrouterine cul-de-


sac
Differentials Rule In Rule Out
GESTATIONAL -one of the possible reasons for 1st Patient:
TROPHOBLASTIC trimester bleeding PE: uterus unenlarged
DISEASE: MOLAR Patient: TVS: (6/21/2017) Within a slightly enlarged
PREGNANCY (+)10x greater risk for >40 y/o uterus there is a well-defined gestational
sac.
(+)amenorrhea
(+)minimal vaginal bleeding TVS (07/3/17):
Normal sized retroverted uterus
Normal ovaries with corpus luteum in the
left ovary

Others:
(-)snowstorm appearance (Complete mole)
(-)thickened, multicystic placenta along with a
fetus or
at least fetal tissue.( Partial mole)
a complete mole appears as an echogenic
uterine
mass with numerous anechoic cystic spaces but
without a
fetus or amnionic sac. The appearance is often
described as a
snowstorm
FIRST-TRIMESTER SPONTANEOUS -one of the possible reasons for 1st trimester bleeding
ABORTION
-abortion as pregnancy termination before 20 weeks gestation or with a fetus born
weighing
< 500 g.
Patient:
(+)Maternal Risk Factor: Early Pregnancy infection (UTI;May 26, 2017)
-advanced paternal age (?)
History:
signs and symptoms started as: (+) hypogastric pain and vaginal
spotting which became (+) vaginal bleeding, with passage of
meaty materials
PE:
Cervix soft, uterus unenlarged (-) adnexal mass,(-) tenderness,(+)
minimal vaginal bleeding, placental tissues plugging the os
TVS:7/3/17
Suggestive of retained products of conception
TYPES OF ABORTION RULE IN RULE OUT
THREATENED bloody vaginal discharge or cervix should be closed
bleeding

INEVITABLE Vaginal bleeding (-) sudden gush of vaginal fluid


followed by vaginal bleeding

INCOMPLETE (+) Vaginal bleeding


(+) cervix dilated
(+) TVS: suggestive of retained
products of conception

COMPLETE (-)expulsion of the entire


pregnancy
(-)during examination, the
cervical os is closed
MISSED (+)vaginal spotting The patient progressed to
vaginal bleeding and
(+)passage of meaty materials