Question

Ashley is a 29-year-old G6 P5 who presents to the emergency department with heavy vaginal bleeding and contractions. She has had no prenatal care but is approximately 33 weeks of gestation by her LMP (Last menstrual period). During her medical screening examination Ashley admitted to past cocaine use and reported that her boyfriend punched her in the abdomen earlier in the day.

Assumptions—Describe an underlying assumption about each of the following issues:

• Possible diagnoses for Ashley
• Laboratory and diagnostic tests necessary to diagnose the cause of Ashley's bleeding
• Management options for Ashley
• Need for a social work consultation regarding intimate partner violence

Answer 1

The signs and symptoms of Ashley raises the assumption of an inevitable or a complete abortion.the fact that she gives a history of her boyfriend punching her at the abdomen explains us the cause of abortion. A blood test for Beta HCG can prove that the lady is pregnant .A Complete Blood count would be checked to assess Hb count,wbcA ultrasound will be a gold standard diagnostic tool to diagnose abortion .

Management options for Ashley includes fluid management as she is bleeding ,option of whole blood transfusion if the Hb is borderline of 7 which can reduce even further ,dialation and curettage for complete removalof conception matter .she should be started on tranexamic acid injection which will reduce the bleeding .she will need a generous dose of analgesics to get rid of pain .she will also need a broad spectrum antibiotics .

Ashley needs a counselling to bear the loss of abortion and dysfunctional family background .she should be referred to a social worker for partner violence .the boyfriend can be charged for violence and cause of abortion.she needs counselling on drug abuse,