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  #1  
Old 08-10-2011
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ObGyn 10 Weeks Pregnant with vaginal discharge

A 10 week pregnant female comes to her primary doctor for evaluation of brown vaginal discharge that happened once 3 weeks ago and again last night. She denies any breast tenderness, vomiting, etc...Physical examination is unremarkable. Cervix is closed..whats the most appropriate next step in management?
A---B-HCG level
B---vaginal ultrasound
C---methotrexate
D---reassurance and follow up
E---check fibrinogen levels
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  #2  
Old 08-10-2011
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B hcg levels !!!!!!!!
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Old 08-10-2011
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yeah, b-hcg levels indeed!
she has no N/V, breast tenderness which should happen now, so we better check b-hcg first, and then go for u/s.
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Old 08-10-2011
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Nope...GIve u a hint...Brown Vaginal Discharge before and now means its a missed abortion....Since she doesnt have any cardinal signs of pregnancy 10 weeks in to it and she has a close cervix....and B hcg lvls are elevated weeks after an abortion.
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Old 08-10-2011
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Quote:
Originally Posted by Kais_MD View Post
Nope...GIve u a hint...Brown Vaginal Discharge before and now means its a missed abortion....Since she doesnt have any cardinal signs of pregnancy 10 weeks in to it and she has a close cervix....and B hcg lvls are elevated weeks after an abortion.
then it's ultrasound.
i know that b-hcg remains elevated weeks after pregnancy cuz the placenta keeps secreting it: it's the fetus thats dead, but why is n/v and breast tenderness absent?

and where u getting these questions from:::they're good!
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Old 08-10-2011
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my mind is clicking a bit different > vaginal bleeding without cervical dilation > threatened abortion ....so i'd like to choose > D--- reassurance and follow up
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I'm Predictable In The Unpredictable Future !
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  #7  
Old 08-10-2011
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Originally Posted by cool_atomic View Post
then it's ultrasound.
i know that b-hcg remains elevated weeks after pregnancy cuz the placenta keeps secreting it: it's the fetus thats dead, but why is n/v and breast tenderness absent?

and where u getting these questions from:::they're good!
hahaa..i actually made this up cuz i came across a little explanation on why only after a missed abortion you need an ultrasound because not all the products of conceptions are evacuated....so a transvaginal US to detect more and possibly D/C afterwards..and since its an abortion hence not a continued pregnancy ..So all the signs of early pregnancy arent there anymore....The Devil is in the Details....
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Old 08-10-2011
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oh, i was wrong. it s not the b hcg levels !!!!!!!!!!!
MISSED ABORTION case !
transvaginal usg the answer...............

a good review !!!!!!!!

thanks.
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Old 08-10-2011
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I agree answer is missed abortion so ultrasound should rule out any fetal material retention
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Old 08-10-2011
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Originally Posted by Kais_MD View Post
hahaa..i actually made this up cuz i came across a little explanation on why only after a missed abortion you need an ultrasound because not all the products of conceptions are evacuated....so a transvaginal US to detect more and possibly D/C afterwards..and since its an abortion hence not a continued pregnancy ..So all the signs of early pregnancy arent there anymore....The Devil is in the Details....
i hope they don't make you a question writer for the real exam! we'd be screwed 4 sure!!! lol
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Old 08-10-2011
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i hope they don't make you a question writer for the real exam! we'd be screwed 4 sure!!! lol
well i didnt know these concepts so i make questions out of the hard topic i dont really know or easily over look that way it stays in my memory better...thats one i thing i like about this forum..I wish everyone would make questions...
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Old 08-10-2011
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B---vaginal ultrasound
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  #13  
Old 08-11-2011
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Thanks dear for putting the idea this way. its a nice useful way.
the answer is B.
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