The document discusses several common differential diagnoses in obstetric clinical practice based on various presenting symptoms. The size of the uterus can indicate multifetal pregnancy, fetal macrosomia, polyhydramnios, or uterine tumors if larger than expected, or small fetus, intrauterine fetal death, or oligohydramnios if smaller. Bleeding in early pregnancy may be due to abortion, ectopic pregnancy, or molar pregnancy. Acute abdominal pain could result from abortion, ectopic pregnancy, appendicitis, or complications of pregnancy. Watery vaginal discharge may stem from ruptured membranes, amnionitis, or vaginitis. Convulsions in pregnancy could have several potential causes including preecl

1. OBSTETRIC CASE TAKING
17 September 2019 Osama M. Warda, MD
Osama M Warda MD
Prof. of OB/GYN
Faculty of Medicine
Mansoura University
EGYPT
2

2. COMMON PROBLEMS
DIFFERENTIAL DIAGNOSIS IN CLINICAL
OBSTETRICAL PRACTICE
17 September 2019 Osama M. Warda, MD

3. The uterus is LARGER than the period of
amenorrhea in the following conditions:
1. Miscalculation.
2. Multifetal pregnancy ( twins or more)
3. Fetal macrosomia; generalized or localized
macrosomia e.g. fetal ascites , tumors.
4. Polyhydramnios
5. Hydatidiform mole ( 50% of them ).
6. Uterine tumors with pregnancy ( e.g.
fibroids.)
7. Concealed accidental hemorrhage
17 September 2019 Osama M. Warda, MD

4. The uterus is SMALLER than the period of
amenorrhea in the following conditions:
1.Miscalculation
2.Small for- date- fetus including IUGR
3.Intrauterine fetal death including missed
abortion
4.Oligo-hydramnios
5. Incomplete hydatidiform mole
17 September 2019 Osama M. Warda, MD

5. BLEEDING EARLY IN PREGNANCY (vaginal)
1.Abortion (see types next slide)
2.Ectopic pregnancy
3.Molar pregnancy
4.Local gynecological cause (infection-tumor-
trauma)
5.General cause for bleeding
17 September 2019 Osama M. Warda, MD

6. 17 September 2019 Osama M. Warda, MD
Table (1-7): Clinical types of abortion.
Type Bleeding Discharge Ut. size cx. os Fever Septicemia
Threatened + - = amenorrhea closed - -
Inevitable +++ - < amenorrhea open - -
Incomplete ++ - < amenorrhea open - -
Complete + + < amenorrhea closed - -
Missed + ++ brown < amenorrhea closed - -
Infected Any Pus Any Any + -
Septic any Pus Any Any ++ +
Cervical abortion is a sub-type of inevitable abortion in which the products of
conception are in the cervical canal.

7. DD of bleeding 1st trimester bleeding
17 September 2019 Osama M. Warda, MD
Molar
pregnancy
Ectopic
pregnancy
AbortionItem
•Diagnosed
preg
• Bleeding
(prune juice)
• +/-passage
vesicles
•Short or no
amenorrhea
• Bleeding
• Pain+/- syncop
•Diagnosed preg
• Bleeding
• Pain
Clinical
•No fetus
• Snow storm
appearance
•Empty uterus
• ? Adnexal GS
• ? Free pelvic
fluid (blood)
•I.U fetus or
remnants of
conception
Ultrasound
(tvs better)
•Markedly
elevated than
expected for GA
•No doubling
within 48 h
•Proportionate to
the GA or lesser
ß-HCG

8. Bleeding late in pregnancy
(3rd trimester)
1.Placenta previa
2.Placental abruption
3.Vasa previa
4.Rupture uterus during pregnancy
5.Local gynecologic cause (infection-tumor-
trauma)
6.General cause of bleeding
17 September 2019 Osama M. Warda, MD

9. Acute abdominal pain
in early pregnancy:
1. Abortion
2. Ectopic pregnancy
3. Appendicitis
4. Complicated ovarian cyst
5. Cystitis
6. Acute pyelonephritis
7. Peritonitis
17 September 2019 Osama M. Warda, MD

10. Acute abdominal pain late in pregnancy
1. Labor pains (preterm or term)
2. Placental abruption
3. Uterine rupture ( prior uterine scars)
4. Appedicitis ( abnormal site for appendix)
5. Acute pyelonephritis (fever+ rigors)
6. Cystitis
7. Chorioamnionitis
17 September 2019 Osama M. Warda, MD

11. Watery vaginal discharge in pregnancy
1. Ruptured fetal membranes
2. Amnionitis
3. Vaginitis/cervicitis
4. Urine
17 September 2019 Osama M. Warda, MD

12. Convulsions in pregnancy
1. Epilepsy (history/ no hypertension)
2. pre-eclampsia/eclampsia synd.
3. Tetanus
4. Tetany (eg. Parathyroid removal)
5. Meningitis/encephalitis
6. Strychnin poisoning
17 September 2019 Osama M. Warda, MD

13. Jaundice in pregnancy
1. Intrahepatic cholestasis of pregnancy
2. Acute fatty liver of pregnancy
3. HELLP synd: (↑ BP & prot. is +ve).
4. Biliary obstruction: (u/s → gallstones).
5. Viral hepatitis: (↑ serum SGPT,SGOT)
6. Hemolytic anemia
17 September 2019 Osama M. Warda, MD

14. Thank you
17 September 2019 Osama M. Warda, MD