Abortion Case Discussion

– History –

• CC: most likely will present as a pregnant lady w\ PV bleeding:
  • Onset: first time? When? Sudden\gradual? Continuous\intermittent?
  • Characteristics: amount? Color? Clots? Tissue? Smell?

• Associated sx:
  • Constitutional: fever, chills, appetite?
  • Anemia: dizziness, syncope, headache, palpitations, SOB?
  • Labor: abdominal cramps, lower back pain, pelvic pressure, fetal movements?
  • Vagina: vaginal bleeding, clear fluid gush\leak, discharge, itching?
  • Urinary sx: dysuria, flank pain?
  • Preeclampsia: headache, visual changes, epigastric pain, lower limb swelling?

• Obstetric Hx:
  • Gravida? Para? Abortions? Living?
    • If prev: mode of delivery? Fetal\maternal complications?
  • LMP?
  • Last US: when? Results? Singleton or multiple gestation?
  • Screening: GBS, GDM, rubella immunization, blood type\Rh immunization?

• Gynecological Hx:
  • Menstrual Hx: regular periods? Intermenstrual bleeding?
  • Contraception use, IUCD?
  • Gynecological procedures, IVF\induction of ovulation?

• PMHx:
  • Diseases:
    • Chronic ds (HTN, DM\GDM, DLP)
    • Cardiac, thyroid, SLE
    • Hematological (anemia, APS)
    • Gyn (PID, fibroids, uterine anomalies)
  • Medications: abx, steroids, anticoagulants, folate, herbal
  • Surgery, hospitalization, trauma
  • Allergies

• FMHx:
  • Similar complaint?
  • Same diseases as in PMHx?

• Social Hx:
  • Occupation, marital status, children?
  • Smoking, alcohol, recreational drugs? (exposure to diethylstilbestrol)
  • Travel Hx
  • Diet, exercise

– Causes –

• Fetal:
  • Chromosomal (MC: trisomy 16)
  • Congenital anomalies

• Maternal factors:
  • Infections (TORCH)
  • Endocrine ds
  • Thrombophilia (SLE, APS)
  • Anatomical abnormalities (septate uterus, Asherman’s)

– Management –

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