Vaginal Bleeding Answers 457into account negative tests, as in the urine dip, as well as positive ones to
narrow in on the diagnosis. These can be tricky, as some stones are obstructing
and do cause hematuria.
412.The answer is d.(Rosen, pp 228-229.)In any patient who is pregnant
withvaginal bleeding,it is imperative to obtain a type and screen in order
to identify the Rh statusof the patient. Rhesus isoimmunization is an immuno-
logicdisorder that affects Rh-negative mothers of Rh-positive fetuses. Any
transplacental maternal exposure to fetal Rh-positive blood cells can initiate
this, whether its origin is traumatic or not. Initial exposure leads to primary
sensitization and the production of antibodies. In subsequent pregnancies,
these maternal antibodies can then cross the placenta and attack the fetal
Rh-positive blood cells. Prevention can be accomplished by giving RhoGAM
to all mothers who are Rh-negative. Administration of the immune globulin
can be given prophylactically at 28 weeks or at the time of maternal exposure.
(a)A CBC would be required if the patient described increased bleeding or had
signs of anemia or hypovolemia (eg, shortness of breath, dizziness). (b)A basic
metabolic panel does not add any information regarding this patient's presen-
tation.(c)A coagulation panel would be useful if you suspected a bleeding dis-
order or if the patient was hemorrhaging. (e)The patient does not have signs
or symptoms of a urinary tract infection.
413.The answer is c.(Rosen, pp 2413-2416.)This patient presents with
vaginal bleedingand a closed os,which narrows the diagnosis to either a
threatened, complete, or missed abortion. The ultrasound examination reveals
anintrauterine pregnancythat is still present without a fetal HR,which
confirms the missed abortion.A dilation and curettage and Rh prophylaxis
is warranted to prevent further infection and coagulopathy.
(a)A threatened abortion is defined as any vaginal bleeding with a
closed os and no passage of fetal tissue, in the first 20 weeks of gestation.
(b)A complete abortion is the passage of fetal products and placenta. (d)An
inevitable abortion is vaginal bleeding with an open cervical os but no passage
of fetal products. (e)An incomplete abortion is the passage of fetal products,
usually between 6 and 15 weeks of gestation.
414.The answer is b.(Rosen, pp 219-224.)It is important to remember
that sometimes patients come to the ED with benign or normal conditions
in which education and counsel are the treatments of choice.
In this case, it is true that her menstrual flow is early but a one-time
occurrence does not give the diagnoses of dysfunctional uterine bleeding