Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all.A 15-year-old girl began her last menstrual period (LMP) 14 weeks ago. She had a positive pregnancy test 6 weeks ago. On examination, her uterine fundus is at the level of the umbilicus. Fetal heart tones are not heard and no fetus is seen by abdominal ultrasound.
Answer(s): B
Gestational trophoblastic disease is more common in women at the extremes of reproductive age. Uterine size larger than her gestational age calculated from her last menses, the absence of fetal heart tones, and the absence of a fetus by ultrasound confirm the diagnosis. Treatment is evacuation of the uterus.
Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all.A 39-year-old pregnant woman with chronic hypertension at 37 weeks' gestation presents with heavy vaginal bleeding and complains of lower abdominal pain. She also has noted diminished fetal movement since the bleeding began 3 hours previously. On physical examination her uterus is firm (rock hard) and very tender. Fetal heart tones are in the range of 160170 BPM.
Answer(s): E
The features that make placental abruption the most likely diagnosis are the amount of bleeding, chronic hypertension, and an excessively firm (even titanic) uterus that is tender to palpation. Women with a placental abruption may have no bleeding if placental separation occurs only in the center of the placenta.The other signs of pain and tenderness will be present.
Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all.A 32-year-old pregnant woman has a low forceps vaginal delivery after a 3-hour second stage of labor. One hour later the nurse informs you she has excessive vaginal bleeding. On examination, her uterus is firm and nontender, and the uterine fundus is at the umbilicus.
Answer(s): J
The use of forceps and the presence of a firm, nontender uterus of appropriate size suggest vaginal laceration as the cause of postpartum bleeding. The diagnosis is confirmed by a speculum examination. A cervical laceration should also be considered and the cervix carefully inspected at the time of the speculum examination
Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all.A21-year-old woman last menstruated 6 weeks ago. Her menses are usually every 2830 days. She has a past history of chlamydia. One week ago she had a positive home pregnancy test. She complains of mild left lower quadrant pain. Quantitative serum chorionic gonadotropin (hCG) concentrations 2 days ago and today are 6850 and 7685 mIU/mL, respectively. No intrauterine pregnancy is identified by transvaginal ultrasound.
Answer(s): K
Vaginal spotting accompanied by pelvic discomfort in a woman with a prior sexually transmitted infection suggests the diagnosis of an ectopic (tubal) pregnancy. Serum hCG concentrations should increase by at least 67% in 2 days during the first 68 weeks of pregnancy. The subnormal increase in this woman's serum hCG concentrations increases the probability of an ectopic pregnancy. However, approximately 15% of women with a normal intrauterine pregnancy will have a subnormal rise in hCG concentrations. Also, approximately 15% of women with an ectopic pregnancy will have a 48-hour rise in serum hCG concentrations greater than 67%. At hCG concentrations over 5000 mIU/mL, the absence of an intrauterine pregnancy by transvaginal ultrasound provides additional evidence for the diagnosis of an ectopic pregnancy.
Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all.A 29-year-old pregnant woman at 38 weeks' gestation presents to your labor and delivery unit complaining of dizziness, heavy vaginal bleeding, and loss of fetal movement. She had been having uterine contractions for approximately 4 hours, but these stopped when the bleeding began. Her previous pregnancy was delivered by classical cesarean section because of a transverse lie.
Answer(s): F
The clinical features that make uterine rupture the most likely diagnosis are profuse bleeding coincident with cessation of uterine contractions and labor in a woman with a prior classical cesarean section (vertical incision in the uterine fundus). Uterine rupture is uncommon in women with a prior low transverse cesarean section and rare in women with no scar on her uterus. The standard of care is that all women with a previous classical cesarean section be delivered by repeat cesarean section at term before the onset of labor.
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