Wednesday, 18 May 2011



Part I

A 25-year-old Fatema who has borne one healthy child was seen at 7 weeks' gestation based on her last menstrual period and she complained of vaginal spotting and lower abdominal pain. She denied any passage of any tissue through the vagina, trauma or recent intercourse. Her medical history was significant for a pelvic infection approximately 3 years previously. She mentioned that she received contraceptive pills for two years after her first child birth. On examination, temperature was 37oC, pulse rate was 90/minute and BP was 110/70 mmHg. Cardiovascular, chest and abdominal examination revealed no abnormality except tenderness on the right iliac fossa.

Investigations showed Hb was 12g/dl and WBCs was 7000/mm3. Urine analysis showed +ve pregnancy test and uncountable pus cells. A urine sample was sent for culture and sensitivity test. Fatema received sedation for pain and an oral antibiotic was started. After 2 days, Fatema's condition was improved. She was advised to attend the OPD for follow up and antibiotic treatment was continued according to the culture and sensitivity test.

Part II

Two weeks later, Fatema presented to the MCH complaining of severe abdominal pain and slight vaginal bleeding. On examination, her blood pressure was 90/60 mmHg, heart rate was 110 beats/min and temperature was within limits. The abdomen was normal and bowel sounds were present and normal. On pelvic examination, the external genitalia and uterus palpate were normal. There was moderate right adnexal tenderness with palpation. Transvaginal sonogram displayed an empty uterus, an adnexal mass and some free fluid in the Doglas pouch.

An immediate operation was done for Fatema. The next day after operation, U/S was done and confirmed normal pelvic activity. She received oral antibiotics. On the third day post-operative she was discharge in a good condition.

PBL II- section 6

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