Place bheki mlangeni district hospital
2 weeks of menstruation
Mrs vt is 25 year old female who presented with 2 weeks of unending menstruation since the 30th of August, this started after she had a ctop(2 months) done as she did not feel ready to have a child . The blood is always coming out and never stop she has not tired taking anything for it as she did not know where to start and what was causing it .
the blood is mostly red like her normal menstrual but since the 10 I’m the mornings the blood is a bit dark and has more clots than off ten it has started to smell offensive .when in her normal menstrual cycle that wound normally last 3 to 5 days and was constant and never skipped months or had extra days she wound change her sanitary pad 3 times a day but if she had eaten if she would change it 5 times she reports not knowing what is the connection between her periods and her eating adding that it just happens .
Now since the 30th of August she has been changing her pad for the 4 times a day and has not eaten any fish this month and that might have caused her period to be prolong . When she had the ctop done she was told she was going to bleed for a week at most and it has been 2 weeks and now she is worried .
She is a proud mother of a 3 year old girl who she leaves with For that past week she had been more tired and find it hard to concentrate on her day to day tasks like cleaning and her assignment as she is a part time students at unisa.
She has no known allergies ,she has no bleeding disorders and no one in her family has bleeding disorders he has not had any surgery on her uterus ( the scar may bleed as manual vacuum aspiration may have opened the scar and caused her bleeding ). She has no history of stis but has had 3 fungal infection for the past year and a half she uses antifungal creams that she gets at her local clinic has had a Hertfordshire last normal menstrual period was on the 20th of may 2019 she has a gravity of 1 and parity of 2 and 1 miscarriage. She is hive negative ,she does not drink or smoke
The patient looks clinical stable but worries about her menstruation as she constantly looking at her pants and keep her distance.
The patient has no scares ,lessons, excoriations, unusual pigmentation ,patient has no public as it is shaved ,no swelling of the labia majora,clitrous is pink ,labia minora is darker and most ,vaginal opening sufficient and not swelling
Speculum examination the cervix could not properly as was covered in blood
Cervical tenderness present, smooth round and firm
The uterus is midpostionaround 10 to 14 cm in size
Apex bit felt in correct anatomical position
Not in any distress as there is no use on accessory muscles
Mild vibrations 3-1-3 regions anterior and posterior
Mild resonance 3-1-3 regions anterior and posterior
Full blood count (results pending ), in for any clotting disorder, I would expect to see signs of hemolytic anemia like decreased Hb,
The ultrasound showed no fetal remains and placenta was also completely removes but there was a calcified mass found on the fundamental of the uterus it is about 5 to 8 cm
Fine needle biopsy results pending this is to check if the mass is cancerous
No final diagnoses has put is place these are working diagnoses
Psychological – social
The patient seems stressed about the menstruation abouts it reminds her of the choice she made to terminate her pregnancy
Admit to ward to gynecological ward as the was following a ctop and cause of bleeding was not fully understood
To administer normal saline 250 ml, 125 ml per hour(for dehydration)
Iron supplements 5mg once a day with meals (low hb)
Co Trimoxazole 80/400 mg oral once at night (profelases incase on infection)
To advice about diet and eating iron rich foods
Refer to psychological about ctop and the worries she has