First Trimester Bleeding

HISTORY:

Gestational Age: ‍ weeks /7, last menstrual period on ‍

G‍01234 P‍01234 A‍01234

Blood type: Rh‍+-

First trimester ultrasound: ‍ ‍normalnot yet performed



First trimester bleeding for ‍ ‍hoursdays

Type: ‍spottinglightmoderateheavy, ‍with smallwith largewithout clots

Pattern: ‍constantintermittent

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍pelvic pain

‍back pain

‍nausea

‍vomiting

‍dizziness

‍fainting



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Pelvic:

- External genitalia: ‍normal, ‍inguinal lymphadenopathy

- Vagina: ‍normal, discharge ‍normal, ‍malodorous

- Cervix: ‍normal

- Uterus: ‍normal, ‍no cervical motion tenderness

- Adnexa: -R ‍normal, -L ‍normal

- Tests performed: ‍Pap test, ‍HPV DNA, ‍vaginal culture, ‍chlamydia/gonorrhea, vaginal pH ‍< 4.5> 4.5, whiff test with KOH ‍negative

- Performed with chaperone



ASSESSMENT:

‍First trimester bleeding ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍βhCG, ‍blood type and Rh, ‍antibody screen

- Pelvic ultrasound

- Rest

- Expectant management

- ‍Misoprostol

- ‍Analgesics

- ‍Rh(D) immune globulin

- Dilation and curettage

- Repeat βhCG in ‍ 48 hours

- Referral to obstetrician

- Referral to psychologist

- Follow-up in ‍ ‍weeks

- Return if symptoms worsen, if new symptoms develop such as heavy bleeding or fever, or if emotional distress occurs

- Go to ER if severe abdominal pain, severe bleeding, or fever occurs