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  #1  
Old 05-16-2012
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ObGyn First Trimester Vaginal Discharge

A 22-year-old, gravida 1 , para 0, at 13 weeks gestation is brought to the emergency department because of vaginal discharge and lower abdominal discomfort. She has had no passage of tissue from her vagina. She does not use tobacco, alcohol or drugs. She has no history of trauma. Her temperature is 37.0C (98.7F), blood pressure is 128/80 mmHg, pulse is 76/min and respirations are 14/min. Physical examination shows a closed cervix, a slightly tender uterus with a size consistent with gestational age, free adnexae and scant bright red bleeding from the introitus. Ultrasonogram in the emergency department shows normal fetal heart motion. She is anxious and concerned about her baby.Which of the following is the most appropriate next step in management?

A. Quantitative beta-HCG measurement
B. Hospitalization, bed rest and close observation
C. Intravenous infusion of methotrexate
D. Dilation and suction curettage
E. Reassurance and outpatient follow up
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Old 05-16-2012
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Threatened abortion, ans E
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Old 05-16-2012
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E. reassurance
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Old 05-19-2012
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Hi
Tanks for posting the question. I just don get something, this is threatened abortion right? so isn't the best management observation? please help
Thanks
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Old 05-19-2012
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reassurance & followup as an OUTPATIENT is indicated in this case, u dont need to admit the pt to the hospital for observation here. cuz even if the pt developed inevitable abortion there's nothing to do.
the prog of threatened abortion is 50% continue, 50% abort

wiki said Whilst bed rest has been advocated in the past to help ensure that a threatened pregnancy might continue, and in one study possibly helped when small subchorionic hematoma had been found on ultrasound scans,[47] the prevailing opinion is that this is of no proven benefit

so even bedrest in not proven to be benefit
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