OBGYN

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EM@3AM: Placental Abruption

A 31-year-old G3P2 female at 32 weeks gestation is brought in by EMS after a fall with complaint of lower abdominal pain. Exam reveals gravid abdomen with lower abdominal tenderness and no signs of bruising. External pelvic exam shows no signs of trauma, but there is scant blood at the introitus. Fetal heart rate is measured at 110 bpm with bedside ultrasound. What is the patient’s diagnosis? What is the next step in your evaluation and treatment?

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EM@3AM: Pelvic Inflammatory Disease/Tubo-ovarian Abscess

A 23-year-old female presents with acute onset lower abdominal pain with abnormal vaginal discharge. She denies fevers, chills, nausea, vomiting, dysuria, hematuria, diarrhea, and constipation. She is sexually active with one partner of 3 months and inconsistently uses condoms. Speculum exam shows small amount of blood and cervical discharge. What is the likely diagnosis?

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EM@3AM: Placenta Previa

A 37-year-old G4P3003 female at 27 weeks GA presents via EMS for vaginal bleeding. She began having brisk vaginal bleeding after coitus about 30 minutes ago and has saturated 1 pad since onset. She denies associated abdominal pain, cramping, or prior episodes of vaginal bleeding during this pregnancy. On exam, her abdomen is gravid, soft, and non-tender. On external pelvic exam, she has no visible lesions, and the maternal pad she is sitting on is about 50% saturated with blood. What’s the diagnosis? What’s the next step in your evaluation and treatment?

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