เลือดออกในระยะตงั้ ครรภ์ บุญส่ง สุประดิษฐ์ Phd. (Education administration) MNS (Maternal and Child Nursing) APN (Maternal and Neonatal Nursing)
• • •GA •Period Preembryonic Embryonic WEEK 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 Abortion Preterm Term POSTterm Fetal Organdev. CNSHEART EyeFacialSkul CephalicFinger LIMB
CASE 1 Bleeding pre Vagina Hx :19 years old, 13 weeks GA Imp: Bleeding per vagina is smelly water discharge with abdominal pain PE : Unwell and has been fever last 48 hours. : BT 38.1๐C P 98 bpm BP 110/60 mmHg Look Flushes and peripheral are warm : Chest & Cardiac examination are normal : Uterus size 14 weeks with tenderness over uterus, No guarding or rebound Lab : On 11 weeks GA US1 : Nuchal scan reassuring Trans Vg US : CRL 42.7 mm Fetal heart ansent CBC : Hb 10.4 gl/dl (11-14) WBC 24.5 x109 /L (6-16 x109 /L) Neutrophils 18x109 /L (2.5-7 x109 /L) Platelet 556x109/L (150-400109/L) Electrolyte : Na+ 135 mmol/L (130-140) K+ 3.4 mmol/L (3.3-4.1) Creatinin : 80 mmol/L (34-82) C.reactive prot 127 mg/L (<5 mg/L) Speculum exam : Cx Closed, Offensive blood strain discharge is seen. Bimanual exam : Reveal a very tender and hot uterus that also feel ‘ Boggy’ No Adnexal masses are palpable but bilateral adnexal tenderness is evident.
Case 1 Question What is the Diagnosis? What do you differential diagnosis? How do you care? History do you want to know? What are this case complication?
Complication of Septic miscarriage. Massive hemorrhage Hysterectomy Disseminated intravascular coagulopathy. Multisystem failure (Secondary to haemorrhage or sepsius) Maternal Death
Management Broad – spectrum intravenous antibiotic. On IVF Surgical evacuate Retained Foley’s for monitor renal function Transfer to ICU depending on her cardio-vascular, respiratory and hematological state.
Key point Septic Miscarriage --- terminate of pregnancy Complete evacuation Eliminate the focus of infection
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