A 35 years lady presented with 12
weeks amenorrhoea with per vaginal
bleeding.
Dr. Atia Afreen
DGO Student
Mymensingh Medical College
Particulars of the Patient
Name: Mrs. Yasmin
Age: 35 years
Religion: Islam
Occupation: House Wife
Address: Bank Colony, Jamalpur.
Date of admission: 12th March 2012
Date of examination: 12th March 2012
Pregnancy for 12 weeks.
Per vaginal bleeding for one day
Mild lower abdominal pain for 12 hours.
History of present illness
According to the patient’s statement, she was
reasonably allright 12 weeks back. Then she
became pregnant with the usual sign
symptoms of pregnancy. She had no h/o
antenatal check up. About one day prior to
her admission she noticed sudden onset of
per vaginal bleeding. At first bleeding was
scanty in amount which was increasing
gradually & was aggravated by minor stress
like defaecation & diminished by rest.
History of present illness…….
She also complained of mild lower
abdominal pain which was intermittent
and radiating towards the back. Pain was
not associated with nausea & vomiting.
Her bowel & bladder habit was normal.
With the above mentioned complaints she
was admitted in this hospital for proper
management.
History of past illness
She had no history of D.M., HTN,
Tuberculosis, & other medical diseases.
She had undergone LUCS for three times.
The last LUCS was performed on
February,2008.
Personal History: Nothing contributory
Family History: Nothing contributory
Socio-economic History: Belongs to middle
class family.
Immunization History: She is immunized
against Tetanus & Hepatitis B virus as
per schedule.
Drug History: Nothing contributory.
Contraceptive History: Couple practiced
barrier method .
Menstrual History
•
•
•
•
•
•
Menarche: at the age of 13 years
Menstrual period: 3-5 days
Menstrual cycle:28±2 days
Menstrual flow: averege
LMP:10/12/2011
EDD: 17/09/2012
Obstetrical History





Married for
Gravida
Para
Stillbirth
ALC
:
:
:
:
:
16 years
4th
3(LUCS)+0
1
4 years
General Physical Examination
Appearance: Anxious
Body built: Average
Dicubitus: On choice
Weight: 60 kg
Height:5 ft 3 inches
Pulse: 90 beats/min
Blood pressure: 100/70 mm of Hg
Respiratory rate:18/min
General Physical Examination….
Temperature: 36.5⁰ c
Anaemia/ Pallor:mild
Jaundice: absent
Cyanosis:absent
Oedema:absent
Dehydration-nil
Lymphnode: not palpable
Thyroid gland: not enlarged
Systemic Examination
Cardiovascular system
Respiratory system
Alimentary system
Nervous System
:
:
:
:
NAD
NAD
NAD
NAD
PER ABDOMINAL EXAMINATION




Inspection:
Umbilicus was centrally placed & inverted.
A transverse scar measuring about 4” was
present 1” above the symphysis pubis.
Palpation:
Abdomen was soft and non tender. Fundal
height-not palpable
Percussion: not done.
Auscultation: Bowel sound present
Pelvic Examination
o
o
o
Inspection:
Vulva and vagina
:Looks apparently healthy.
P/V bleeding-present
Per Speculum Examination: Cervix was broad,bluish
in colour. Fresh blood comes out from os.
Bimanual Examination:
Cervix was soft, broad,distended & the uterus was
about 12 weeks of size.OS was closed. Fornices
were not tender & had no adenexal masses.
SALIENT FEATURES
Mrs. Yasmin 35 years old, housewife , 4th
gravida with h/o three LUCS at term was
admitted on 12th March 2012 at her 12
weeks of pregnancy with the complaint of
per vaginal bleeding for the past one day
associated with mild lower abdominal pain
which was intermittent in nature. She
seeks medical advice as per vaginal
bleeding was gradually increasing.
SALIENT FEATURES…..
Her medical history was unremarkable, with
no previous h/o pelvic inflammatory
disease, or insertion of intrauterine
devices. She practiced barrier method for
contraception. Her menstrual cycle was
regular with average flow. On examination
the patient was found anxious, mildly
anaemic, non icteric & non oedematous.
Her blood pressure was 100/70 mm of Hg,
pulse-90 beats/min.
SALIENT FEATURES…..
The abdomen was soft & no evidence of
tenderness, guarding and rigidity. Pelvic
examination revealed vulva &vagina
apparently healthy, Cervix was soft, broad
& distended & the size of uterus was about
12 weeks . Os was closed with fresh
bleeding escaping through os. No fornicial
tenderness & had no adnexal masses.
Clinical Diagnosis
4th gravida with threatened
abortion with previous h/o three
c/s
DIFFERENTIAL DIAGNOSIS



Cervical ectopic pregnancy
Pregnancy with cervical fibroid
Molar pregnancy.
Investigations
General
Blood for Hb: 9.8 gm/dl
Random blood sugar: 5.7 mmol/L
Blood grouping & Rh typing: B positive
VDRL Test: Non reactive
Urine R/M/E: Sugar-nil Pus cell-1-2/HPF
Albumin-nil
RBC-nil
Investigations……
Specific
 Ultrasonogram of lower abdomen-12+1
weeks of gestational age of cervical
pregnancy with empty uterine cavity.
 Serum beta HCG- 20,000 IU/L
Confirmed diagnosis
4th gravida with 12 weeks
cervical ectopic pregnancy
with previous h/o three c/s.
Management
AIM- Termination of pregnancy
Management…
Definitive managementTermination of pregnancy was done by
dilatation,evacuation & currettage under general
anaesthesia. Curettage revealed products of
conception from the distended cervical canal.
The amount of product curetted out
corresponded to about 12 weeks of pregnancy.
Management………
Profuse haemorrhage continued despite of
curettage and pressure, the cervix appeared like
a elongated flabby loose fold of tissue. Foley’s
catheter tamponade was attempted, failing which
exploratory laparotomy with total abdominal
hysterectomy was performed to save the life of
patient. Patient was taransfused 3 units of blood
peroperatively.
Management………
After hysterectomy specimen was sent for
histopathological examination.
Management………
Her post operative period was uneventful and
she recovered well.