APGO MEDICAL STUDENT EDUCATIONAL OBJECTIVES, 11TH EDITION Teaching Case Student Name: Educational Topic 16: Spontaneous Abortion Rationale: Spontaneous abortion is a common and often distressing complication of early pregnancy. An accurate and prompt diagnosis is warranted. Intended Learning Outcomes: A student should be able to: • • • • • Develop a differential diagnosis for first trimester vaginal bleeding. Differentiate the types of spontaneous abortion (missed, complete, incomplete, threatened, septic). List the causes of spontaneous abortion with consideration of ethnic, racial, and cultural disparities in health outcomes. List the complications of spontaneous abortion with consideration of social and structural determinants of health outcomes. Discuss treatment options for spontaneous abortion, with consideration for patient safety and value-based care. EPAs covered: 1, 2, 4, 7, 9, 10, 11 TEACHING CASE A 32-year-old G1P0 patient (she/her/hers) presents with a positive urine pregnancy test at 9 weeks 4 days from the start of last menstrual period. She reports 5 days of moderate painless vaginal bleeding. Physical examination shows a temperature of 98.6 F (37 C), pulse 85 beats/minute, and blood pressure 105/60 with normal bowel sounds, no rebound, and 5/10 suprapubic tenderness. Pelvic exam demonstrates a moderate amount of blood in the vagina with a closed cervix and non-tender uterus. No adnexal masses or tenderness. Lab data shows a serum b-hCG level of 6,500 mIU/ml and ultrasound shows a gestational sac with a yolk sac present in the uterus with no embryo seen. The ovaries and tubes appear normal. Copyright © 2021 by Association of Professors of Gynecology and Obstetrics (APGO) For permissions: apgoadmin@apgo.org 1 APGO MEDICAL STUDENT EDUCATIONAL OBJECTIVES, 11TH EDITION Unit 2: Obstetrics, Section B: Abnormal Obstetrics ET 16: Spontaneous Abortion COMPETENCY-BASED DISCUSSION & KEY TEACHING POINTS Competencies addressed: • • Patient Care Medical Knowledge 1. What are the different types of spontaneous abortion and how are they defined? Text 2. What management is recommended for this patient if she became febrile, tachycardic, and hypotensive with uterine tenderness? 3. If this patient was at an estimated gestational age of 6 weeks, had an b-hCG level of 700 mIU/ml and a negative ultrasound with no evidence of a gestational sac, what would be the differential diagnosis if she had a small amount of bleeding and no fever or tenderness? Copyright © 2021 by Association of Professors of Gynecology and Obstetrics (APGO) For permissions: apgoadmin@apgo.org 2 APGO MEDICAL STUDENT EDUCATIONAL OBJECTIVES, 11TH EDITION Unit 2: Obstetrics, Section B: Abnormal Obstetrics ET 16: Spontaneous Abortion 4. For a patient with any type of abortion, what blood test is essential? 5. What are the causes of spontaneous abortion? 6. What are treatment options for spontaneous abortion? REFERENCES Casanova R, et al. Beckmann and Ling’s obstetrics and gynecology. 8th ed. Philadelphia: LWW, 2018. Hacker NF, Gambone JC, Hobel CJ. Hacker & Moore’s essentials of obstetrics and gynecology. 6th ed. Amsterdam: Eslevier, 2016. ACOG Practice Bulletin 200. Early pregnancy loss. 2018. Available from: https://www.acog.org/clinical/clinicalguidance/practice-bulletin/articles/2018/11/early-pregnancy-loss Copyright © 2021 by Association of Professors of Gynecology and Obstetrics (APGO) For permissions: apgoadmin@apgo.org 3
