Critical Cases: Abdominal Cramping and Vaginal Bleeding
Tue, 08/13/2019 - 5:11am
- 25 y/o Female, G3P2012, presenting with vaginal bleeding.
- Patient notes bleeding began last week and is longer than typical menses
- Pt notes suprapubic abdominal cramping
- 98.6 / BP 119/77 / Pulse 110 / RR 18 / SpO2 99%
- Abdomen: Soft, mild surprapubic tenderness, no rebound, guarding, or rigidity
- Pelvic: Clot noted in vaginal vault, no active bleeding. Mild uterine tenderness on bimanual
- Menstruation, Dysfunctional Uterine Bleeding, Menorrhagia, Fibroids, Malignancy, Threatened Ab, Miscarriage, Ectopic Pregnancy
- Upreg positive
- b-hCG quant pending
- Type and screen
POCUS: No IUP. Complex L adnexal mass with some surrounding free fluid.
- Level 2 to OR with OB-gyn for ruptured ectopic pregnance (see image below)
- Urine pregnancy test for all women of childbearing age for abdominal pain or vaginal bleeding
- Be suspicious of patient attributing vaginal bleeding to menses, this could still be an ectopic pregnancy!
- Ultrasound findings of a complex adnexal mass must be attributed to ectopic pregnancy until proven otherwise, regardless of the serum beta-quant