OBGYN Homework 2: Gynecology Teaching Round

Name: PHUTHAPTHIM SUNANSINEE

ID: 3190300067

Question 1:
• HCG that day is 1500 IU/L, you send her back.
• HCG follow-up every 48 hours are: 700, 500, 300, 120, 70IU/L.
• The patient has a fever, 38.4 ℃, mild uterine tenderness, empty uterus on ultrasound
examination.
• What’s the mostly likely diagnosis and what’s the management?
• Provide supporting evidence (UpToDate, guideline, literature...) for your
management choice

(1) The most likely diagnosis is Septic abortion (Post-abortion infection).

① Explanation:
In this case the patient with a serum B-HCG level that has declined to have an abortion.
The ultrasound shows as empty uterus, mild uterine tenderness, and patient also has a fever
38.4℃.

② Conclusion:
Septic abortion typically refers to pregnancies of less than 20 weeks’ gestation and refers to
any abortion, spontaneous or induced, that is complicated by uterine infection, including
endometritis. Therefore this case is on the septic abortion.

(2) Management:
The management of this patient also has broad-spectrum antibiotics with anaerobic coverage and
uterine curettage.

(3) References(supporting evidence)：

Refers from the information of this case.
 Question 2
• HCG that day is 1500 IU/L, you send her back.
• HCG follow-up every 48 hours are: 700, 500, 300, 180, 160.
• No symptoms except light vaginal bleeding every day.
• What’s the mostly likely diagnosis and what’s the management?
• Provide supporting evidence (UpToDate, guideline, literature...) for your
management choice

(1) The most likely diagnosis is Complete abortion.

① Explanation:
- A discharge of fluid from patient vagina.
- A discharge of tissue from patient vagina.
- No longer experiencing the symptoms of pregnancy, such as feeling sick and breast
tenderness.

② Conclusion:
A pregnancy < 20 week’s gestation in which all the products of conception have passed; the
cervix is generally closed. Because all the tissue has passed, the uterus no longer contracts, and
the cervix closes. Therefor the patient of this case is on complete abortion.

(2) Management:
The management is Surgical treatment is the choice for this case and using uterine curettage and
manual vacuum is another way.

(3) References(supporting evidence):

Providing supporting evidence: Medical management Abortion of WHO 2018