Divine Word Hospital

DEPARTMENT OF
OBSTETRICS AND GYNECOLOGY

SGD #2

Date of consult: December 7, 2020

FS, 42-year old G3P3 (3003) arrived at the DWH Emergency Room for profuse vaginal bleeding. Patient has no
known co-morbidities, no vices, no history of contraceptive use. She had her menarche at 13 years old, with
irregular intervals. Last normal menstrual period was on October 10-13, 2020. Three days prior to consult, she
had vaginal spotting soaking 1 pantyliner per day. On the day of consult, it progressed to bleeding fully soaking
3 all-night pads and now associated with hypogastric pain and passage of meaty material. Persistence of
bleeding prompted consult.

At the emergency room, BP 100/60 HR 88 bpm R R 18 cpm Temp 37C. Abdomen was soft nontender.

On speculum exam, no vaginal masses noted, cervix smooth with blood clots per os. On internal examination,
she had normal external genitalia, parous vagina, cervix open, corpus enlarged to 8-10 weeks size, no adnexal
masses or tenderness. On rectovaginal exam, no fullness in the cul de sac

Pregnancy test done: +

Transvaginal ultrasound:

A. Sagittal view showing focal echogenic mass within the endometrial cavity
B. Coronal view showing same mass
C. Color Doppler shows blood flow within the mass
No adnexal masses noted
Both ovaries normal
No free fluid in the cul de sac