It is presentation for care to be given during abortion

1. Case Presentation:
Sagar Pokhrel
BAMS 23rd Batch,2075
Roll No: 06

2. Case no 1:
 A 25 years nulliparous woman walks into the OPD with 1 and
half month period of amenorrhea with slight spotting for 2
hrs.
 She does not complain of any pain. She has done a home
based pregnancy test which is positive.
 On pelvic examination, the uterus is about 6 weeks in size and
the os is closed.
 How do you proceed?
 What is the likely diagnosis?

3. Contd:
 The TVS shows an intrauterine gestational Sac with an embryo
of CRL 5 mm and cardiac activity is present.
 There is a small subchorionic hemorrhage.
 How is the woman managed?

4. Case 2:
 25 year old nulliparous, pregnant woman 1½ month
amenorrhea.
 Mild bleeding for 2 hours ,Cramping lower abdominal pain .
 Uterus is 6 weeks in size and Os is open.
 What is the likely diagnosis?
 How do you manage?

5. Case 3:
 25 year old nulliparous, pregnant woman presents with 3
month of amenorrhea.
 Bleeding for 2 hours, soaked 3 pads fully
 Cramping lower abdominal pain
 Uterus is 6 weeks in size and Os is open
 How do you proceed?
 The TVS shows that the uterus is bulky in size with irregular
endometrial stripe and hyperechoic contents measuring
about 2 * 3 cm, likely retained products of conception.
 How do you manage?

6. Case 4:
 25 year old nulliparous, pregnant woman with 2 month
amenorrhea walks into the OPD with bleeding P/V for 4 hours
with cramping lower abdominal pain.
 She has soaked 3-4 pads fully but now the bleeding and pain
has subsided.
 On examination, the uterus is bulky and the os is closed.
 There is no active bleeding.
 TVS reveals that the uterus is bulky in size with a thick
endometrial stripe but the cavity is empty.
 What is the likely diagnosis?
 How do we proceed?

7. Case 5:
 30 year old multiparous woman is wheeled to the casualty
with severe bleeding P/V for past 2 hours and cramping lower
abdominal pain.
 She is extremely pale and her PP 110/min and her BP is 80/50
mm Hg.
 How do you proceed?

8. Contd.
 Immediate resuscitation
 Immediate investigations
 Arrange blood
 Quick Hx:
 There is h/o preceding amenorrhea for 3 months.
 There is also h/o MTP pill intake.
 On examination, the abdomen is soft.
 Her undergarments are completely soaked by blood.

9. Contd:
 On P/V examination, the uterus is 6 weeks in size, the os is
open and products of conception can be felt in the vagina.
 What is the diagnosis?
 How do we manage?