Early Pregnancy Obstetrics
Diagnosis and treatment of lower abdominal pain accompanied by spotting in pregnancy can be challenging. Such symptoms can be associated with non-obstetric and obstetric causes. A thorough history has to be taken from a patient presenting with such symptoms for an appropriate treatment plan to be developed. Some likely causes of lower abdominal pain during pregnancy are appendicitis, urinary tract infection, miscarriage, ectopic pregnancy, constipation, and urinary tract infection. Spotting in pregnancy can be caused by implantation bleeding, a cervical polyp, sexual intercourse, a gynecological exam, and heavy lifting. All these must be considered for the right diagnosis and treatment plan to be established in a patient with spotting and lower abdominal pain.
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The questions I would ask the patient would be aimed at establishing the cause of the symptoms. Such questions are: May you please show me the position where you are experiencing the lower abdominal pain? How frequently has the spotting persisted? Has the spotting become heavier or lighter? When was the last time you had sexual intercourse? Have you seen any abnormal discharge other than spotting? Are you experiencing other symptoms like a burning sensation when urinating, frequent urination, or urine that appears cloudy?
After listening to the patient’s responses, I would order ultrasonography, urinalysis, and HCG tests. An ultrasonography would be appropriate as it would help evaluate the patient’s abdomen. Ultrasonography has a high specificity and sensitivity for diagnosing causes of abdominal pain (Zachariah et al., 2019). A urinalysis would help rule out the presence of an infection. Even though the HCG test may not detect miscarriage or ectopic pregnancy, more HCG tests can be done in the future and compared to the current HCG level to determine if there is a risk of miscarriage or ectopic pregnancy. It has been shown that HCG levels double in pregnancy. A miscarriage or ectopic pregnancy is possible if the HCG levels do not double (Priyanka et al., 2019). Management of the patient would be based on what I find out as the likely cause of the symptoms. For instance, if the urinalysis results point towards the presence of an infection, I would recommend an appropriate treatment regimen for the patient. However, I would still refer the patient to OB/GYN for a more comprehensive assessment.
Overall, it is necessary to consider all etiological factors associated with lower abdominal pain and spotting in pregnancy. A thorough history has to be taken, and appropriate laboratory tests should be done. Management of the patient would be based on the findings of the laboratory tests and information obtained from the history.
References
Priyanka, M. D., Rati, M. D., Lal, M. D. M., & Anita, S. D. (2019). Association of serum hCG level with miscarriage in early pregnancy. International Journal of Clinical Obstetrics and Gynaecology, 3(3), 141–144. https://doi.org/10.33545/gynae.2019.v3.i3c.273
Zachariah, S. K., Fenn, M., Jacob, K., Arthungal, S. A., & Zachariah, S. A. (2019). Management of acute abdomen in pregnancy: Current perspectives. International Journal of Women’s Health, 11, 119–134. https://doi.org/10.2147/IJWH.S151501
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A 20-year-old 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 conclusion. Review the rubric carefully before submitting.
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