Spontaneous Abortion Case Study Essay Paper
complete the Aquifer case titled Family Medicine 12: 16-year-old female with vaginal bleeding and UCG.
After completing your Aquifer Case Study, answer the following questions using the latest evidenced based guidelines:
Discuss the questions that would be important to include when interviewing a patient with this issue.
• Describe the clinical findings that may be present in a patient with this issue.
• Are there any diagnostic studies that should be ordered on this patient? Why?
• List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.
• Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.
You are working at an outpatient family medicine clinic with Dr. Hill. She has asked you to interview and examine Savannah, a 16-year-old who has come in for a routine sports physical before the softball season begins. Her mother, Leslie, accompanies her.
Dr. Hill informs you, “This is one of the special aspects I love about family medicine: I have cared for Savannah and her entire family since I helped Leslie deliver Savannah 16 years ago!”
She continues, “Today, in addition to performing a pre-participation physical examination, I would like to use this opportunity to perform prevention screening and counseling. Perhaps the most important ‘screening’ issue is the medical interview and developing a safe and trusting doctor-patient relationship. Since this can sometimes be challenging with adolescents, I have found it helpful to organize my interview around the adolescent interviewing mnemonic, HEEADSSS.”
Logistically, you both decide that it would probably be best to begin the history with Savannah’s mother present and then delve into more of the interview after she has been invited to the waiting room during the conclusion of the visit.
Later that morning, Savannah’s laboratory and imaging come back with the following results:
CBC: WBC = 9.3 x103/?L (9.3 x109/L), Hgb = 12.1 g/dL (121 g/L), Hct = 36.3% (0.36), Platelets = 176000/mm3( 176 x109/L)
Wet prep: no trichomonas, no yeast, no clue cells
Quantitative beta-hCG = 1492 mIU/mL
Progesterone = 14.5 nmol/L
Transabdominal and transvaginal ultrasound report:
No intrauterine pregnancy is noted
Left ovarian cyst 3cm
Cannot rule out ectopic pregnancy
Ten days later, you are covering the emergency room with Dr. Hill. The nurse approaches you to inform Dr. Hill that Savannah is here:
Nursing Note:Patient presenting with vaginal bleeding. Her mother says that she is two months pregnant. Her vitals signs are BP 105/75 mmHg, pulse of 90 beats/minute, and a temperature of 36.9 C (98.4 F).”
Dr. Hill thanks the nurse and asks you to accompany her. As you enter the room, Savannah recognizes you and begins to cry. She tells you she has been bleeding on and off for about an hour, with some clots, and a fair amount of pain, but when you ask she tells you she hasn’t had any dizziness or light-headedness.
Dr. Hill says, “Savannah, we need to examine your abdomen and cervix like we did a few weeks ago in the office. Like before, it will involve the speculum to allow us to see, then it will involve a hand in your vagina and another on your abdomen. Is it all right with you if the student performs the exam?”
Savannah responds, “That’s fine. I don’t have any questions yet.”
Dr. Hill assists you in performing a pelvic exam. You find:
Pelvic Exam:Some pooled blood in the vaginal vault. On both the speculum and digital exam, the os appears to be opened to about 1-2 cm. Her abdominal exam reveals normal bowel sounds on auscultation, no tenderness on palpation, and is soft.
Dr. Hill then states to Savannah and Leslie, “I’m going to ask the ultrasound technician to perform another ultrasound, that will allow me to assess the fetus’ heart rate. We should be able to obtain the ultrasound images through your lower abdomen this time.”
Several minutes later, you and Dr. Hill are called to the ultrasound room.
Abdominal Ultrasound: No detectable fetal heart rate. The fetus’ crown-rump length measures 0.65 cm, or approximately 6w4d gestation, similar to the last ultrasound.
“Savannah,” Dr. Hill begins, “your fetus does not have a heartbeat. That means that the fetus has died. I’m sorry.”
Leslie gently but tearfully indicates that they would like a few moments alone.
Dr. Hill excuses you and herself from the room so you may discuss the findings, promising to return in a moment.