Assignment – Early Pregnancy/Obstetrics
Assignment Prompt
A 20-year-old G1P0A0 female presents to your clinic complaining of crampy lower abdominal pain and spotting. She states her last period was 5 weeks ago, she took a home pregnancy test yesterday and it was positive. She states she tried to make an OB appointment, but they could not get her in for several weeks. What questions would you ask this patient? Describe how you would assess and treat this patient using evidence-based practice.
Research: Citations required in-text and references.
Length: At least 825 words, not including references.
Citations: At least five high-level scholarly references in APA 7 from within the last 5 years.
Sample Answer
Early Pregnancy/Obstetrics
Evaluation Questions for the Patient
For the 20-year-old patient presenting with crampy lower abdominal pain and spotting, I would ask several questions to the patient to obtain adequate gynecologic health history of the patient. The first question would be to ask the patient the date of the last menstrual period and the frequency of their monthly periods, and the amount of bleeding they normally witness during their menstrual periods (Abdulkareem & Eidan, 2017). The second question would be to ask the patient if they are sexually active and the number of sexual partners we are involved with. The third question would be to ask the patient whether they are using any type of birth control method. I would also ask the patient to highlight if they have had a history of sexually transmitted diseases in the past and whether such diseases were treated (Abdulkareem & Eidan, 2017). I would then ask the patient to highlight if they have had any previous gynecologic procedures performed on them. Finally, I would ask the patient if they have had any previous pregnancies and whether they went through normal delivery or a cesarean section delivery (Abdulkareem & Eidan, 2017).
In the case of the 20-year-old patient, a confirmatory pregnancy test would be conducted, and subsequent obstetric history relating to prior pregnancies of the patient conducted using the GTPAL framework (Sotelo, 2019). These would include G (gravida), representing the number of pregnancies the patient has gone through. T for term births representing the number of children the patient has had born after 37 weeks. P the premature births representing the number of children the patient has born before 37 weeks and finally the number of abortions and miscarriages a patient has had. L represents the number of living children of the patient would also be evaluated (Sotelo, 2019). For the 20-year-old patient G1P0A0Would, therefore, represent that the patient has only had one pregnancy and no history of premature births or abortions and miscarriages.
Assessment and Treatment of the 20-Year-Old Patient
The assessment of the 20-year-old patient complaining of crampy lower abdomen pain and spotting would include considering whether the patient has adequate airway clearance, breathes effectively, and has effective circulation. Circulation would therefore need to be addressed if the patient shows symptoms of poor perfusion such as difficulty breathing, dizziness, and altered meditation (Helton, 2019).
For the 20-year-old patient, the suspected source of spotting and cramping lower abdomen pain would be an ectopic pregnancy. The pregnancy status of the patient will therefore need to be established as soon as possible. The performance of a formal pregnancy test on the 20-year-old patient presenting with spotting and crampy lower abdomen pain would therefore need to be conducted as one of the first tests (Helton, 2019). A negative pregnancy test would still make the suspicion of an ectopic pregnancy high, especially if the patient has not had their latest menstrual period. A positive result on the pregnancy test of the 20-year-old patient would then lead to examination on whether the patient’s pregnancy is intrauterine or extra-uterine (Kömürcü Karuserci & Sucu, 2020). This is because, according to Kömürcü Karuserci & Sucu (2020), ruptured ectopic pregnancy is a surgical emergency that needs immediate emergency laparoscopy. For the 20-year-old patient, bedside ultrasonography would be conducted to determine the location of the pregnancy. The last menstrual period and gestational age of the patients are vital components of the patient’s history that can play a significant role in helping to determine the effective treatment for the patient (Krutika et al., 2021).
A pelvic exam would also be an important assessment procedure for the 20-year-old patient. A pelvic examination would start through the visualization of the external genitalia and the patient’s anus for lesions. Careful examination of the 20-year-old patient’s vagina and cervix would also be conducted to assess any form of lesions and lacerations that might be causing spotting (Krutika et al., 2021). The pelvic examination would also involve looking for various products and signs of conception protruding from the patient’s vaginal canal or cervix. Cervical specimens will then be collected and sent to the laboratory to look for various infections such as yeast, bacterial vaginosis, trichomonas, as well as gonorrhea, and chlamydia (Krutika et al., 2021). Empiric antibiotic treatment would be recommended for a patient at a higher risk of various forms of vaginal infections (Kömürcü Karuserci & Sucu, 2020).
For the 20-year-old patient in the case study, her signs and symptoms would include irregular spotting and crampy lower abdominal pain combined with assessments confirming that the patient is pregnant and an ultrasound that would confirm the presence of an ectopic pregnancy. A ruptured ectopic pregnancy would require an immediate surgical emergency. On the other hand, the treatment of a simple ectopic pregnancy would be a laparoscopy or the administration of methotrexate if the ectopic is less than 4 cm in diameter (Sotelo, 2019).
