Case+1+-+Second+Trimester+Bleeding

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A 36 y/o G5P3 presents to OPD at the district hospital with complaint of vaginal bleeding. She states she found out she was pregnant at her local clinic 4 weeks ago after missing 2 cycles of her period. She has not had any antenatal care yet due to distance problems, however upon experiencing blood spotting she decided to seek medical advice. Spotting has been occurring for three days. No tissue has ben passed. She denies any pain or cramping, and no recent intercourse. This is a surprising but desired pregnancy as her next youngest is 8. She underwent b/l tubal ligation 5 years ago.

No past medical history. All previous deliveries vaginal with no other obstetrical complications.

Examination: Pulse 92 BP 112/72 O2 sat 99% RA RR 18 Temp: Afeb Gen: A and O x 3, NAD. Well appearing Abd: gravid, FH 20cm to umbilicus. +bs, nd, nttp, no adnexal masses or tenderness Ext: no peripheral edema, pulses 2+ b/l dorsalis pedis GU: small amount of dark old blood in the vault, with visually closed cervix normal appearing, confirmed on digital exam, nontender.

What do you do now CCRMC res? You grab your ultrasound of course which is never more than 6 feet away at any time.



I know looking at static US images is not easy. This is an iphone image and the quality WILL improve. Specifically, this thick ringed structure is, as you guessed, the uterus. As you scan through, there is no identfiable IUP, nor any masses in the adnexa.