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Patient profileJ.Y.17 y/o SingleRoman Catholic Sta Lucia Agdao,Davao City
G1P0
Chief Complaint
Profuse vaginal bleeding
OB HistoryNo. Yea
rSex
Indication for C/S
Place of Delivery
Attending
BW
Complications
n/a n/a n/a n/a n/a n/a n/a
n/a
G1P0 LMP- December 26, 2008 AOG- 18 weeks
3/7PMP- November 26, 2008 EDC- October 2,
2009
Menarche: 13 y/oSubsequent Menstrual Period:
regular, lasting for 5 days soaking 1-2 pads/day
Coitarche: 17 y/o, with 1 sexual partner
Papsmear: none
Family Planning Method: none
Gyne history
(+) childhood measles & chickenpox(-) DM (-)HPN (-)BA (-)CA
Past Medical Hx
(+) HPN – father(+) Ovarian Cancer – maternal (+) Brochial Asthma – patenal side(-) Heart disease(-) PTB(-) DM
Family Hx
Does not smokeSlight alcoholic beverage drinker No known food & drug allergiesFresh graduate from HS
Personal/Social History
Review of SystemsHEENT: No history of head injury, good vision,
good hearing occasional mild colds, occasional canker sores and no alarming complaints on the bucal cavity and pharynx
Neck: no pain and difficulty in swallowing, no complaints of tender lymph nodes
Cardio: no chest pain, no palpitations
Pulmo: no dyspnea, no cough
Gastrointestinal: abdominal pain on the hypogastric region, no vomiting, claimed to have mild diarrheic stools, no hematochezia
Urinary: no frequency, no hematuria, no dysuria
Review of Systems
History of Present IllnessHistory of Present Illness4 months
PTA(+) vaginal bleeding soaking 2 pads per day
metrorrhagia
(+) increase in abdominal girth
no associated sings and symtoms
2 months PTA
(+) metrorrhagia soaking 2 pads per day
(+) palpable abdominal mass between the symphysis pubis and the umbilicus
no associated sings and symtoms
History of Present IllnessHistory of Present Illness1 day PTA
Profuse vaginal bleeding
(+) nausea
(+) pallor
Palpable abdominal mass almost at the level of the umbilicus
Admission
PHYSICAL EXAMINATION
conscious, coherent, not in cardiorespiratory distress
BP: 120/80CR: 70 bpmRR: 20 cpmT: 36.8oC
Palms warm and dry. no rashes.
Nails without clubbing and cyanosis.
Hair of average texture. Scalp without lesions
Physical ExaminationConjunctiva pink, anicteric sclerae. Extraocular movements intact.
Acuity good. No gross ear deformities, no ear discharges
Nasal mucosa pink, septum midline. No sinus tenderness
Physical ExaminationOral mucosa pink. Moist lips and tongue, no tonsillar enlargement, pharynx without exudate.
No palpable masses, No enlargement of thyroid gland. No carotid bruit, Trachea midline.
Physical Examination symmetrical chest expansion, no intercostals retraction, equal tactile fremitus, lung fields are resonant, vesicular breath sounds w/ no added adventitioussounds
adynamic precordium, good S1 and S2, no murmurs, regular rhythm and normal heart rate.
Symmetric, without masses,Nipples w/out discharges and retraction.
Physical Examination
flat, Normoactive bowel sounds (16/min) tympanitic no hepatomegaly or
splenomegaly
Palpable abdominal mass at the level of the umbilicus
Physical Examination
No edemaNo varicosities, no ulcers
Physical Examination
Radial Femoral Popliteal
Dorsalis pedis
Posterior tibial
Right +2 +2 +2 +2 +2
Left +2 +2 +2 +2 +2
alert and cooperative, thought coherent, oriented to person, place and time.
(+) Nystagmus
able to do nose pointing and rapid alternating movements.
Intact cranial nerves
Intact pinprick, light touch, position, and vibration sensation
Physical Examination
+2 +2 +2
+2 +2 +2
+2 +2
+2 +2
R LUpper
extremities: 5/5 5/5
Lower extremities
5/5 5/5
SpeculumSmooth, pinkish cervix with no lesions
foundCervix is non-dilated
Internal ExaminationCorpus enlarged to ~20 wks size, fixedNo adnexal mass/tenderness
Pelvic examination
MetrorarrgiaNausea pallorGradually Increasing abdominal mass
4 months PTA- increase in abdominal girth2 months PTA- palpable abdominal mass between the
symphysis pubis and the umbilicus1 day PTA- palpable abdominal mass almost at the level of
the umbilicus
No pressure signs and symptoms
Salient Features
Pelvic ExaminationCorpus enlarged to ~20 wks size, fixedNon-dilated cervix
Impression
Pregnancy Uteri G1P0 18 3/7 weeks AOGHydatidiform Mole
Differential Diagnosis
Submucous myomaEctopic pregnancyThreatened Abortion
Differential DiagnosisFeatures Patient Submucou
s myomaEctopic Pregnancy
Threatened Abortion
Age/incidence
17 years old
>35 years old
2% 15%*
Metrorrargia
(+) (-) * (+/-) * (+)
abdominal mass
(+) (+) * (+) * (+)
Pressure signs and symptoms
(-) (+)* (-) (+/-)
Nausea and pallor
(+) (+/-) (+) (+/-)
Pain (-) (+/-) (+) * (+)Enlarged globular corpus
(+) 20 weeks AOG
(+) * (+/-) (+)
Cervical dilatation
(+) (+) (+) (+)*
Differential DiagnosisFeatures Patient H-moleAge/incidence 17 years old 1 0f 1500
pregnanciesMetrorrargia (+) (+)abdominal mass (+) (+)Pressure signs and symptoms
(-) (-)
Nausea and pallor (+) (+) *Pain (-) (-)Enlarged globular corpus
(+) 20 weeks AOG (+) *
Non-dilated cervix (+) (-)
Management Diagnostic studies:
Quantitative B-hCGTransvaginal Ultrasound
Dilation and suction curettageIV oxytocin should be administered
Follow-up for development of GTThCG determinations (48 hours, 3 consecutive
weeks, every 6 months, and then yearly)PE (Pelvic exam at regular intervals)Birth control (1 year- OCP, Depo Provera)
DiscussionH-mole
Molar pregnancy is characterized histologically by abnormalities of the chorionic villi that consist of trophoblastic proliferation and edema of villous stroma
2 forms: Complete & Partial
DiscussionCOMPLETE
1. Hydropic degeneration and swelling of the villous stroma
2. Absence of blood vessels in the swollen villi.3. Proliferation of the
trophoblastic epithelium to a varying degree
4. Absence of fetus and amnion.
ManagementDilatation and Suction curettagebHCG monitoring
Good day