Early Pregnancy – Assessments and Supportive Care

Early Pregnancy – Assessments and Supportive Care

The patient in the presented case visited the clinic with chief complaints of lower abdominal pains after having a positive pregnancy test. Accordingly, the first step would be confirming the case using PDT. Once it is confirmed, an ultrasound will be done to see the position of the fetal pole. It helps to rule out blighted ovum and ectopic pregnancy. Additionally, more patient symptom history is required to ensure accurate diagnosis and appropriate intervention.

Relevant Questions

The first question would be about the onset of pain and whether it was gradual or sudden (When did the pain start, and was it gradual or sudden?). Abdominal cramps can be part of normal physiological changes in pregnancy. However, there is a need to rule out differentials such as molar pregnancy, ectopic pregnancy, and abortion. The second question would be on character, severity, and site of pain (What is the character, severity, and site of pain?). This question aims to determine whether the pain radiates, grading it on a 1-10 scale and laterality. Unilateral, severe pain with an acute onset can be due to ectopic pregnancy, which is ruled out by a transvaginal ultrasound scan.

The third question would be on the onset of spotting in relation to the pain (When did the spotting start?). The main causes of early pregnancy bleeding include implantation, ectopic pregnancy, infections, molar pregnancy, cervical polyps, subchorionic hemorrhage, sexual intercourse, and physical examination (McAllister et al., 2022). Recent sexual activity should be ruled out in history, leaving the other differentials for imaging. Up to 20% of patients have bleeding in their first trimester due to hormonal changes, a normal physiological change. The last question would be about the characteristics of spotting (Does the flow increase, and does it have blood clots?).

Assessment and Treatment Using Evidence-Based Practice

Apart from history, physical examination, lab work, and imaging are important for this patient. The physical examination aims to check on the patient’s overall well-being, especially symptoms of anemia. After that, a transvaginal ultrasound is done to confirm the site of pregnancy to rule in or out of ectopic pregnancy. If the pregnancy is normal, then lab work on the first prenatal visit is done. These include hemoglobin level, urinalysis, VDRL, and RVD serology.

Treatment of this patient depends on the diagnosis from history, examination, imaging, and lab work. In the case of ectopic pregnancy, methotrexate is administered at a dose of 1.0mg/kg i.m, on days 0, 2, 4, and 6. Folic acid is taken on alternate days for four days. Methotrexate blocks the enzymes that maintain pregnancy, preventing the mass from growing and preventing rupturing (Grigoriu et al., 2022). The body absorbs the mass within 4-6 weeks. If it is an abortion, possibly a threatened abortion, administering progesterone and HCG and addressing the cause is the most appropriate treatment (Mouri et al., 2021).

However, if it is a normal pregnancy, the patient is started on iron and folic acid supplements and given the first tetanus injection. Additionally, the presence of yeast and pus cells in urinalysis tests is managed using antifungals and antibiotics. The patient is also educated on safety measures during pregnancy and the importance of attending all clinic visits. Additionally, the patient and the spouse are given emotional support.

In conclusion, many causes of early pregnancy bleeding are accompanied by pain. A thorough history, physical examination, and imaging are done to narrow down the diagnosis. Management is offered according to the cause, and the patient is educated on future prevention practices. Lastly, it is important to reassure the patient by offering emotional support.

References

Grigoriu, C., Bohiltea, R. E., Mihai, B. M., Zugravu, C. A., Furtunescu, F., Georgescu, T. A., & Munteanu, D. I. (2022). The success rate of methotrexate in the conservative treatment of tubal ectopic pregnancies. Experimental and Therapeutic Medicine, 23(2), 1-7.

McAllister, A., Lang, B., Flynn, A., Meisel, Z. F., Abernathy, A., Sammel, M. D., & Schreiber, C. A. (2022). Pregnant and bleeding: A model to assess factors associated with the need for emergency care in early pregnancy. The American Journal of Emergency Medicine, 53, 94-98.

Mouri, M., Hall, H., & Rupp, T. J. (2021). Threatened abortion. In StatPearls [Internet]. StatPearls Publishing.

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A 20-year-old G1P0A0 female presents to your clinic complaining of crampy lower abdominal pain and spotting. She states her last period was 5 weeks ago. She took a home pregnancy test yesterday and it was positive. She stated she tried to make an OB appointment but they could not get her in for several weeks. What questions would you ask this patient? Describe how you would assess and treat this patient using evidence-based practice. Submissions should be in APA format and should include an introduction and a conclusion.