Somali Medical Forums

Medical Student Forums => Problem-Based Learning Center => Topic started by: Admin on March 30, 2009, 09:47:51 PM

Title: Case (52)
Post by: Admin on March 30, 2009, 09:47:51 PM

31yrs old female presented with recurrent abortion every 8 weeks for 4 times,
She has 4 children alive & well whom are deliverd thru SNVD.

The patient looks well & she is'nt complaining nothing except these repeated miscarriages which she belives started after she married her current husband without knowing the reason.

The patient has gone through many investigations including MRI, Ultrasound, Hormonal essay & even immunological tests.

The patient is feeling well for the first 2 months then suddenly she feels pain and abortion happens without prodromal symptoms & there are no symptoms/signs indicate maternal infections.

After I have seen her medical reports all are concluded with: Nothing abnormality detected.

The patient does'nt smoke & not on drugs/medications.

What is the diagnosis?
What other questions you would like to ask this patient?
What is the treatment/advice?

Title: Re: Case (52)
Post by: Aduka on April 02, 2009, 01:17:40 AM

Diagnosis: cervical incompetence
Other Q's: Any Hx. of DVT's Or PE's
Rx: Caution to avoid exercise and stress; Cervical cerclage, although trials have revealed disappointing results.

Title: Re: Case (52)
Post by: Aduka on April 02, 2009, 01:21:04 AM

I dn't think this is a standard question. Next time ask good questions.

Title: Re: Case (52)
Post by: Admin on April 02, 2009, 09:08:13 AM

Your answer is wrong because:

Cervical incompetence cause miscarriage or preterm birth during the second and third trimesters.

Cervical incompetence cause dilation and effacement of the cervix occur without pain or uterine contractions.

Cervical incompetence is unlikely to happen after successful previouse pregnancies.

Thanks for the hard work & try again.

Title: Re: Case (52)
Post by: Munim on April 03, 2009, 11:36:23 PM

1-I think diagnosis is
spontaneous abortion(Miscarriage)

2-we ask about this:-
A-Chromosomal investigation of the couple bcz Almost 40-50% of all early losses are due to genetic abnormalities in the baby.
B-Chronic illnesses:-diabetes, severe high blood pressure, kidney disease

3-Treatmen may be:
-Hormone treatment
-progesterone supplement in early pregnancy
-Antibiotics
-Good Rest.

Title: Re: Case (52)
Post by: Admin on April 04, 2009, 12:22:36 PM

Thanks Dr.Munim for your diagnosis

Spontaneous abortion is a naturally occurring event but when it becomes so frequent it should worry a doctor.
Though complications and defects in the chromosomal development of the fetus cause up to 70% of spontaneous abortion cases but other physical cause was responsible for this problem as I understood from her after careful & deep history.
So I added to the list of your advices "Please avoid sex when you miss your period" & this saved her from the abortion & now she is 6 months pregnancy & feels her fetal movement.

Thanks again.