A pregnant patient at 5 weeks' gestation reports slight amount of vaginal bleeding. The clinician should recognize that the following laboratory test should be done:
A. Serial HCG levels over the next several days
B. Measurement of estrogen levels
C. Cervical mucus analysis
D. Pap smear for sexually transmitted infection
ANS: A
Approximately 20% of early pregnancies are complicated by vaginal bleeding, and about half of these will end in spontaneous abortion (Deutchman, 2008). Single or serial qualitative hCG levels can be helpful in evaluating vaginal bleeding during early pregnancy because the levels should double every 2 to 3 days during the fourth to eighth weeks of gestation.
Assessment questions should be directed toward any precipitating factors of bleeding (e.g., after sexual intercourse), the amount of vaginal bleeding (saturation of sanitary napkins and frequency with which the napkins must be changed), the quality of the vaginal bleeding (clotted versus flowing), and whether the bleeding is actually coming from the vagina or from the urethral or rectal area.
The vital signs should be normal for gestational age. Physical examination should concentrate on uterine size, FHTs, a pelvic examination with cervix visualization, and a digital rectal examination. Other tests that may be useful include a transvaginal ultrasound, hCG level measurement, progesterone level, wet mount, urinalysis, and stool for occult blood. A CBC and coagulation studies should be considered.
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