Family Medicine 12 – 16-year-Old Female with Vaginal Bleeding and UCG

Family Medicine 12 – 16-year-Old Female with Vaginal Bleeding and UCG

Savannah is a 16-year-old healthy female who presented to the Ambulatory Family Medicine Clinic for a pre-participation exercise sports physical examination. During this particular interaction, she claimed to have had unprotected sexual intercourse and was provided with counseling on contraception and pre-conception. When she came back after two weeks, she complained of morning sickness, sore breasts, and fatigue. Another urine pregnancy test confirmed the pregnancy. The subsequent visits presented signs such as vaginal bleeding, and after several tests, it was determined that Savannah had a miscarriage. The differential diagnoses, the diagnostic plan, and the adequate management and follow-up of Savannah’s condition, as discussed in this essay, are in line with practice today.

Differential Diagnoses

Regarding differential diagnoses of Savannah’s case, there was ectopic pregnancy or molar pregnancy (gestational trophoblastic disease). Mullany et al. (2023) also note other conditions such as ectopic pregnancy where the embryo is planted in a part of the fallopian tube, abdomen, or cervical and may present symptoms of miscarriage such as abdominal pain and vaginal bleeding. This diagnosis was made because there was no intrauterine pregnancy during the first ultrasound examination and the presence of left ovarian cysts. This was, however, dismissed when subsequent ultrasounds showed an intrauterine pregnancy before the miscarriage.

The second differential diagnosis was molar pregnancy, which occurred due to the incorrect differentiation of trophoblasts. This condition was considered due to the first-time abnormal bleeding and ultrasound results. However, regarding the other typical features, including high beta-hCG levels, the presence of a fetus with cardiac activity in previous scans was also useful in excluding this diagnosis. These diagnostic reflections, admitted alongside the clinical course of Savannah’s case, led to the primary diagnosis of miscarriage.

Diagnostics

When diagnosing Savannah, several tests were conducted to ensure that she was indeed pregnant and to determine the stage of pregnancy. The first tests were urine pregnancy tests and quantitative beta-hCG levels. Measurable beta hCG is helpful regarding the chances of pregnancy and complications, such as an ectopic pregnancy (Demetrio Larraín & Caradeux, 2024). Savannah’s beta-hCG levels were normal for early pregnancy, but there was no intra-uterine pregnancy on the first ultrasound.

A transvaginal ultrasound was done to better visualize the uterus and the adnexal structures. This imaging technique is quite useful when diagnosing early pregnancy complications such as ectopic pregnancy, molar pregnancy, and miscarriage (Hendriks et al., 2020). This was because of a final diagnosis that was made through a follow-up ultrasound in which there was no fetal heartbeat seen and significant cervical change suggesting inevitable miscarriage.

Treatment, Education, and Follow-Up

Savannah’s care plan was based on her concerns about miscarriage and other women’s health issues, such as reproductive health. First, they were offered consultation concerning the pregnancy, which is an essential component of client management in such cases. If there was a miscarriage, the management plan had medical or surgical intervention if required, based on the symptoms of the woman or her preference.

Other management strategies in cases of missed or inevitable miscarriage consist of expectant management, medical management using misoprostol, or surgical management using dilation and curettage (Redinger & Nguyen, 2020). Due to the case of Savannah with severe bleeding and cervical dilation,n surgical intervention was made to ensure that the process of miscarriage was completed and also to avoid other complications such as infection or severe bleeding.

At the end of the treatment, the patient and the family were informed of what to expect once the patient was recovering, signs of complications, and dates for follow-up. Savannah was counseled on contraceptive use to avoid more pregnancies and advised to seek counseling since she was grieving the loss of the baby.

Conclusion

Savannah’s case proves that early pregnancy complications need further diagnostic evaluation and client-focused intervention. Clinical guidelines and evidence-based practices provided the frameworks where formal care, intervention, and management of Savannah’s reproductive health could be delivered. In her case, by getting the correct diagnosis of the miscarriage and attending to her medical and psychological concerns, the healthcare workers dealt with her situation, supporting the idea that patient-centered care is important in improving patient care and health. That is the reason why strict patient education and close follow-up should always be pursued, especially in similar clinical scenarios.

References

Demetrio Larraín, & Caradeux, J. (2024). β-Human Chorionic Gonadotropin Dynamics in Early Gestational Events: A Practical and Updated Reappraisal. Obstetrics and Gynecology International, 2024(24), 1–10. https://doi.org/10.1155/2024/8351132

Hendriks, E., Rosenberg, R., & Prine, L. (2020). Ectopic Pregnancy: Diagnosis and Management. American Family Physician, 101(10), 599–606. https://pubmed.ncbi.nlm.nih.gov/32412215/

Mullany, K., Minneci, M., Monjazeb, R., & C. Coiado, O. (2023). Overview of ectopic pregnancy diagnosis, management, and innovation. Women’s Health, 19(19), 174550572311603. https://doi.org/10.1177/17455057231160349

Redinger, A., & Nguyen, H. (2020). Incomplete Abortions. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559071/

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Essay Elements: PLEASE MAKE SURE IT’S ONLY THREE PAGES LONG, NO MORE, NO LESS
• One to three pages of scholarly writing in paragraph format, not counting the title page or reference page
• Brief introduction of the case
• Identification of the main diagnosis with supporting rationale
• Identification of at least two additional differential diagnoses with a brief rationale for why these were ruled out
• Diagnostic plan with supporting rationale or references
• A specific treatment plan supported by recent clinical guidelines
Please refer to the rubric for point value and requirements. In general, these elements must be covered as per the rubric:
• PLEASE USE CLINICAL GUIDELINES FOR REFERENCES IN APA FORMAT WITHIN THE LAST 5 YEARS.
• PLEASE SEE ATTACHED OUTLINE TO CREATE AN ESSAY

16-year-Old Female with Vaginal Bleeding and UCG

Synopsis
Family Medicine 12: 16-year-old female with vaginal bleeding and UCG

Savannah is a healthy 16-year-old female who presents with her mother to an ambulatory family medicine practice for a routine preparticipation sports exam. The visit includes the development of a trusting doctor-patient relationship to facilitate adolescent health promotion and disease treatment. Immunizations are updated, and an adolescent interview is conducted, revealing that Savannah is engaging in unprotected sexual intercourse. Birth control and preconception counseling are provided, and Savannah is scheduled to return for Depo-Provera and a chlamydia and gonorrhea test.
When Savannah returns to the clinic two weeks later, she reports it is five weeks since her last menstrual period, and she is experiencing morning sickness, breast tenderness, and tiredness. A urine pregnancy test is positive. She is given pregnancy options counseling. A week later, Savannah returns due to vaginal bleeding. Her pulse and blood pressure are normal, and the pelvic exam is unremarkable. Quantitative beta-hCG is 1492 mIU/mL. Ultrasound does not reveal an intrauterine pregnancy, but a left ovarian cyst is noted. After reviewing the differential diagnosis, it is determined that none of the top three diagnoses (spontaneous abortion, ectopic pregnancy, or idiopathic bleeding in a normal pregnancy (i.e., “threatened abortion”)) can be currently ruled out. Two days later, her serial beta-hCG has doubled, the bleeding has subsided, and transvaginal ultrasound reveals an appropriately developing fetus with a heartbeat. Ten days later, at 7 weeks and 4 days gestation, Savannah presents to the emergency department with vaginal bleeding, some clots, and a fair amount of pain. Pelvic exam reveals the cervical os opened 1 to 2 cm with pooled blood in the vaginal vault. On ultrasound, the fetus no longer has a heartbeat, and the inevitable abortion is appropriately managed.

Differential diagnosis:

Just choose two Differential diagnoses:
Spontaneous abortion (miscarriage), ectopic pregnancy, molar pregnancy (gestational trophoblastic disease), vaginal trauma, cervical abnormalities (e.g., excessive friability, malignancy, polyps, trauma), idiopathic bleeding in a viable pregnancy
Final diagnosis: Miscarriage
For reference: Please use clinical guidelines in APA format within the last 5 years