Case Summary
Savannah is a 16-year-old healthy student female who came with her mother for a routine pre-participation softball sports exam. The visit is to promote and establish professional interaction between adolescent patient and healthcare provider. The immunizations are up-to-date and an interview conducted. Unfortunately, during the assessment was revealed that Savannah is engaging in unprotected sex. Therefore, counseling for birth control was given, and Savannah scheduled to return for Depo-Provera, a pelvic exam, and a chlamydia test. Two weeks later, Savannah returns to the clinic and reports that her menstrual cycle is five weeks late since her last menstrual period. Furthermore, she states that she has had morning sickness, breast tenderness, and fatigue. Urine pregnancy test was completed and it was positive. She received counseling, due to unintended pregnancy. A week later, Savannah returns to the clinic with complained of vaginal bleeding. Ultrasound shows a left ovarian cyst, but not a baby grow in the uterus. However, ten days later, Savannah medical conditions deteriorated, and she presents to the emergency with vaginal bleeding and pain. Pelvic examination revealed that cervical is dilated as well as accumulate blood in the vaginal canal. …show more content…
The speculum exam revealed minimal amount of fresh blood in the posterior fornix. The vaginal sidewall was found to be pink and moist, without obvious signs of trauma. The cervix revealed mild ectropion, no obvious masses or lesions, and appeared to be un-dilated. Both a wet prep and cultures for gonorrhea and chlamydia were obtained. On bimanual exam, the cervix was closed; the uterus was felt to be less than 8 weeks size, and non-tender. There were no obvious adnexal masses were palpable. Additionally, there was no unusual cervical motion tenderness or adnexal
Savannah is a 16-year-old healthy student female who came with her mother for a routine pre-participation softball sports exam. The visit is to promote and establish professional interaction between adolescent patient and healthcare provider. The immunizations are up-to-date and an interview conducted. Unfortunately, during the assessment was revealed that Savannah is engaging in unprotected sex. Therefore, counseling for birth control was given, and Savannah scheduled to return for Depo-Provera, a pelvic exam, and a chlamydia test. Two weeks later, Savannah returns to the clinic and reports that her menstrual cycle is five weeks late since her last menstrual period. Furthermore, she states that she has had morning sickness, breast tenderness, and fatigue. Urine pregnancy test was completed and it was positive. She received counseling, due to unintended pregnancy. A week later, Savannah returns to the clinic with complained of vaginal bleeding. Ultrasound shows a left ovarian cyst, but not a baby grow in the uterus. However, ten days later, Savannah medical conditions deteriorated, and she presents to the emergency with vaginal bleeding and pain. Pelvic examination revealed that cervical is dilated as well as accumulate blood in the vaginal canal. …show more content…
The speculum exam revealed minimal amount of fresh blood in the posterior fornix. The vaginal sidewall was found to be pink and moist, without obvious signs of trauma. The cervix revealed mild ectropion, no obvious masses or lesions, and appeared to be un-dilated. Both a wet prep and cultures for gonorrhea and chlamydia were obtained. On bimanual exam, the cervix was closed; the uterus was felt to be less than 8 weeks size, and non-tender. There were no obvious adnexal masses were palpable. Additionally, there was no unusual cervical motion tenderness or adnexal