Pregnant Vag Bleed MDM and DCI
[textarea]This patient in the first trimester of pregnancy presented to the emergency department with complaints of vaginal bleeding and abdominal pain. VSS. Os is closed.[/textarea] A pelvic ultrasound demonstrated [select value="normal intrauterine gestation with normal FHT.|failure to identify a gestational sac.|blighted ovum.|subchorionic hemorrhage."] Rh was [checkbox value="positive.|negative and patient administered Microrogham."] UA was [checkbox value="positive|negative"] for infection. Clinical Impression: [select value="Threatened Miscarriage|UTI|Early Pregnancy vs. Ectopic|Missed Abortion"] [text] Anticipatory guidance, supportive measures and return indications discussed with patient. See DCI. DCI: Bed rest. Pelvic Rest. Drink plenty of fluids. [checkbox value="Take the antibiotics prescribed for urinary tract infection|Follow up with your OB/GYN in 1-2 days|Return here or with your OB in 48 hours for repeat BHCG level|Bring a copy of your results from today's visit"] Return to the ER for increased bleeding (more than 1 pad an hour for consecutive hours), increased abdominal cramping, fever, passage of products of conception, lightheadedness or any other concerns.
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