Ectopic P Regnancy Case Presentation
Ectopic P Regnancy Case Presentation
This is the case of M.G. 24/F Single Building 16, RM 102, Filinvest Housing, Alabang, Muntinlupa City Unemployed Roman Catholic Currently living with her boyfriend
Chief Complaint
Abdominal pain
(+) lower back pain 3/10 in severity, non-radiating (-)dysuria (-) foul-smelling discharge (-) fever (-) urinary frequency (-) consult (-) meds
HPI
3 hours PTC
(+) sudden onset of severe hypogastric pain (+) 10/10 in severity (+) nausea (+) difficulty of urination (-) vomiting (-) fever (-) anorexia (-) vaginal bleeding
(-) consult with a Hilot and was advised to go to the hospital due to severe pain
Obstetrical History
G3P2 (2002)
No. pregnancy
Year
Outcome
Manner of Delivery
Birthweight
Place of Delivery
Complic ations
G1 G2 G3
2007 2009
NSD NSD
2.7 kg 2.7kg
none none
Present pregnancy
MENSTRUAL HISTORY
Menarch:14 years old
Duration: 5-7 days Amount: 2 moderate-fully soaked pads on the 1st 3 days and 2 minimally soaked pads per day on the last 4 days of menstruation
Abnormalities: no dysmenorrhea
GYNE HISTORY
The patient was never been diagnosed of any
gynecologic diseases in the past Never had pap smear family planning method used- withdrawal method
SEXUAL HISTORY
1st sexual contact: 18 y/o with her 1st boyfriend
She is currently living with her 2nd boyfriend who
is the father of her 2 children (-) dyspareunia and post-coital bleeding Last sexual contact:
REVIEW of SYSTEMS
GENERAL: (+)abdominal pain, (-) fever (-) chills INTEGUMENTARY: (+) pallor, (-) cyanosis,
HEAD: (-) lesions (-) swelling (-) headache EYES: (-) tearing (-) redness EARS: (-) discharge
REVIEW of SYSTEMS
PULMONARY: (-) dyspnea, (-) cyanosis
CARDIO: (-) dyspnea, (-) cyanosis (-) palpitation GUT: (+) abdominal Pain (-) vaginal bleeding
REVIEW of SYSTEMS
HEMATOLOGIC: (-) bleeding tendencies
PHYSICAL EXAMINATION
General Survey: The patient is conscious, coherent, cooperative and not in CPD Vital Signs: BP: 80/40 CR: 112 RR: 26 T: 36.5 HEENT: anicteric sclera, pale palpebral conjunctiva, no cervical LAD, no tonsillopharyngitis C/L: SCWE, no retractions, clear breath sounds HEART: AP, tachycardic, no murmur
PHYSICAL EXAMINATION
ABDOMEN: flat with direct and rebound
tenderness on all quadrants INTERNAL EXAM: cervix is closed, with wriggling tenderness, no blood on the examining finger, posterior cul-de-sac noted to be full Bimanual Examination: not assessed due to severe pain
Impression
Severe hypogastric pain T/C UTI , Pregnancy to be ruled out
UTI
Basis for Ruling-in
Severe hypogastric pain Difficulty of Urination
Management:
Diagnostics:
CBC with platelet Count Urinalysis with Pregnancy
Therapeutics:
Fluid resuscitation
test
Diagnosis:
G3P2 (2002) T/C Ectopic pregnancy 6 1/7 weeks AOG R/O Threatened abortion
Ectopic Pregnancy
Basis for Ruling-in based on History
Amenorrhea severe abdominal pain Difficulty of urination
rebound tenderness on all quadrants IE: cervix closed with wriggling tenderness, full Posterior cul-de-sac
During an episode of acute significant hemorrhage, the Initial hematocrit is always the highest 1000ml of blood loss = 3 vol % drop in the hct
volume. Careful measurement of urine volume reflects the adequacy of renal perfusion and perfusion of vital organs.
Urinalysis
Pus Cells: 2-4
RBC: 0-2 Epithelial cells: few
Bacteria: few
Mucus threads: many A. Urates: few Protein: Negative Sugar: Negative
MANAGEMENT
B/P: 80/40 CR: 112
BP 80/50 CR 110 RR 20
FD 300cc of PNSS BP 80/50 CR 114 RR 21
FD 200cc of PNSS
BP 80/50 CR 112 RR 21
SHOCK
condition in which circulatory insuffi-ciency prevents adequate vascular perfusion of vital organs
(20 to 25 mL/hr) as a result of poor perfusion of the kidneys. With further loss of blood the woman becomes agitated, appears weak, and develops skin pallor with cold and clammy extremities. The systolic blood pressure drops below 80 mm Hg. Again, because of adaptive cardiovascular changes, it takes a rapid loss of approximately one third of the blood volume to produce significant hypotension.
circulating blood volume and establish normal cellular perfusion and oxygenation provide 1.adequate ventila-tion because poor respiratory gas exchange 2. rapid fluid replacement with adequate amounts of blood and crystalloid solution (normal saline or lactated Ringer's solution) 3:1 rule