MedBugs: SAQ #332

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Case: Early pregnancy bleeding

A 30-year-old lady presents to your emergency department with lower abdominal pain and vaginal bleeding. She reports a positive urinary pregnancy test and her last menstrual period was 6 weeks ago.

1. List four potential causes for her symptoms. 4 marks

The patient’s bHCG is 7000. Your registrar asks if they can use the departmental ultrasound to ascertain the aetiology of her symptoms

2. Outline four important points when asked whether departmental ultrasound can be used to ascertain the aetiology. 4 marks

The patient has a formal ultrasound showing an intrauterine, 32 mm gestational sac with no foetal pole seen. The bleeding has stopped.

3. Outline your initial approach to counselling and educating the patient regarding a diagnosis of blighted ovum. 5 marks

4. Outline three possible management options for this scenario. 3 marks

5. Give two further aspects of management for this patient. 2 marks

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