GROUP 11

A 25-year-old woman reports that she had a positive home pregnancy test last week and
now has spotting and low abdominal pain of 2 days’ duration. Her last menstrual period
was 6 weeks ago. Her abdomen is minimally tender in the left lower quadrant with no
rebound tenderness. The pelvic examination is normal except for tenderness and a 4 cm mass in
the left adnexa.

a) What are your 4 differential diagnoses?

b) What are the most common clinical manifestation in this case?

c) What are the most diagnostic tests done to diagnose this condition?

d) What are the possible five (5) nursing care in this situation?

A. Differential diagnosis are;

1. Ectopic pregnancy
Because the patient present with spotting,low abdominal pain ,the abdomen is
minimal,tender in the left lower quadrant with no rebound tenderness and pelvic
examination is tenderness and 4cm mass in the left adnexa.

2. Salpingitis.
Salpingitis is inflammation of the fallopian tubes, caused by bacterial infection.
Characterized by Abdominal pain and spotting bleeding.

3. Hemorrhagic corpus luteal cyst

The patient present with abdominal pain, spotting bleeding and adnexa probably it can be
hemorrhagic corpus luteal cyst .

4 .Threatened abortion
It is characterized by bleeding in the first trimester without loss of fluid or tissue Some
patients describe bleeding at the time of their expected menses, sometimes referred to as
implantation bleeding, which may be related to implantation of the pregnancy in the
endometrium. In cases of miscarriage, bleeding usually begins first, and cramping
abdominal pain follows a few hours to several days later. The pain may present as
anterior rhythmic cramps; as a persistent low backache, associated with a feeling of
pelvic pressure; or as a dull, midline, suprapubic discomfort. The combination of
 persistent bleeding and pain usually indicates a poor prognosis for pregnancy
continuation

B. Clinical Findings
I. Adnexa mass 4cm
II. Tenderness without rebound
III. Spotting
IV. Low abdominal pain
V. Positive pregnancy test
Diagnostic tests.

Serum Human Chorionic Gonadotropin Levels

If a positive pregnancy test is found when ectopic pregnancy is suspected, the remainder of
the workup should focus on evaluating the viability and location of the pregnancy. In normal
pregnancies, serum β-hCG levels rise in a log-linear fashion until 60 or 80 days after the last
menses, at which time levels plateau at about 100,000 IU/L. During this early phase of
pregnancy, a 53% or greater increase in serum β-hCG levels should be observed every 48
hours. A rise of hCG levels less than this should raise suspicion for an abnormal gestation,
either intrauterine or ectopic..

Transvaginal Ultrasonography

A gestational sac is usually visible between 4½ and 5 weeks from the last menstrual period
(LMP). The yolk sac appears between 5 and 6 weeks, and a fetal pole with cardiac activity is
first detected at 5½ to 6 weeks. With transabdominal sonography, these structures are
visualized slightly later. Each institution must define a β- hCG discriminatory value (i.e., the
lower limit of serum hCG at which a TVS can reliably visualize pregnancy). It is not
uncommon for TVS to demonstrate an intrauterine pregnancy by the time the hCG level is
1,000 to 2,000 IU/L. Transabdominal ultrasonography should be able to identify an
intrauterine gestation by the time the hCG level reaches 5,000 to 6,000 IU/L. The absence of
an intrauterine pregnancy with β-hCG levels above the discriminatory value signifies an
abnormal pregnancy—ectopic, incomplete abortion, or resolving completed abortion.

Serum Progesterone Level

Serum progesterone concentration is higher in a viable pregnancy than an ectopic pregnancy.

There is minimal variation in serum progesterone concentration between 5 and 10 weeks of
gestation; thus a single value is sufficient. A serum progesterone level of <5 ng/mL has been
used to identify a nonviable pregnancy.

C. Nursing care.
1. Pain management.
 Diclofenac 150mg IM,
 Position the patient so that the abdominal muscles are not over stretched-usually
semi-fowlers or low fowler’s position
2. Psychological support.
3. Monitor accurately food input and output chart.
4. Diet,
 minimize salt intake , greatet than 4g may lead to dehaydration.
5. The vital signs of the patient should be assessed for shock:
 Blood pressure, pulse, respiration, temperature, oxygen saturation levels,
level of consciousness, glucometer readings, and haemaglobin levels and
possibly a measurement of abdominal girth is taken to have baseline
readings..