Admitting diagnosis: Egtopic pregnancy

Chief Complain: The patient presents in the emergency this morning, complaining of decrease abdominal pain. HISTORY OF PRESENT ILLNESS: the patient states that she has been having vaginal bleeding extra like spotting over the previous month, she denies the possibility of being pregnant although she states she is sexually energetic and utilizing no contraception. Gynecologic History: Patient is graved to par 1 abortus 1. her solely child is a year old 15 yr old daughter who lives in Texas that lives together with her grandmother.

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PAST MEDICAL HISTORY: Positive for hepatitis B

PAST SURGICAL HISTORY: Pilonidal cyst eliminated in the distant past, has cosmetic surgery on her ears baby. SOCIAL HISTORY: Married, has 1 daughter, patient works instead teacher, smokes 1 pack of cigarettes on a daily basis. Denies EtOH. Smoked marijuana final night time, no iv drug abuse. ALLERGIES: Tetanus

MEDICATION: None
REVIEW OF SYSTEMS: Patient complains of lower stomach pain for the previous week. Apparently obtained a lot worse last night time, and by this morning wasn’t tolerable.

She can also be having some nausea and vomiting, denies hematemesis and mel?? She has had vaginal recognizing over the previous month with questionable vaginal discharge as well. denies the frequency, urgency and hematuria and denies arthralgia. Review of systems is in any other case essentially negative. PHYSICAL EXAM: Vital indicators show temperature 97 levels. pulse 53 respirations 22. blood pressure 108/60. GENERAL: Physical exam revels a properly developed, properly nourished 35 yr old white female is the moderate quantity of misery the time of the examination, HEENT are all remarkable except poor indentation. neck is soft and supple.

CHEST: Lungs are clear in each fields. HEART: Regular fee and rhythm. ABDOMEN: soft but positive tenderness of her lower abdominal area. Fundus was not palpable. above the pubic space.

Left andexal are greater than tender than the proper. VAGINAL: The cervix is closed. a average amount of motherapulient vaginal discharge is noted. the affected person wouldn’t allow me to perform a bimanual examination because of her pain. so the speculum was withdrawn. EXTERMITIES: No clot or edema. NUEROLOGICAL-in tact urea x3, no nuerologica defictest. DIAGNOSTIC: Dr. on admission hemoglobin 12.eight grams, hemaocrit is 36.6%. urine analysis is essentially unfavorable. beta hcg is optimistic wit the WBC count of 23,278 RADIOLOGY: Pelvic ultrasounds shows a 7 week 4 day without work viable ectopic pregnancy per radiologist. the patient was given Demerol 25mg and Phenergan 25mg iv for the ache after her report was obtained. she was also given Claforan 1 gram iv, I paged Dr. Gerald GYN, doctor as soon as they acquired the ultrasound report at approximately 10 am he was not in his north Miami workplace.

I paged the south Miami office and reached Dr. Gerards workplace at roughly 10:15am. his office personnel advised me that he is not on name, Dr. Vonbeck is on name. I spoke with Dr. Vonbeck at approximately 10:25 am and she or he might be here to take the patient to the working room. ADMITTING DIAGNOSIS: Left Ectopic 1st trimester being pregnant. The affected person obtained and iv of lactated ringer’s upon the arrival within the emergency room. This was regular saline while we were awaiting Dr. Vonbecks arrival. The surgical process was defined the patient and her husband all the danger and advantages have been mentioned. Then assessing in quick surgical procedure and knowledgeable consent was signed. no old information are available for evaluation. Dr McClure end dictation.

Rosemary Bumbak dictating a
OPERATIVE REPORT
Patient Name: Brenda C. Seggerman
Patient ID: 903321
Date of Admission: 03/27/2012
Date of Surgery: 03/27/2012
Surgeon: Rosemary Bumbak, MD
Assistant: Michael Gerard , DO
Anesthesiologist: General and tracheal by Dr. Avalon
Estimated Blood Loss: approximately 1000ml required transfusion of two units
of whole blood. specimen eliminated portion of left fallopian tube containing the ectopic pregnancy. Preoperative Diagnosis: left tubectoipc pregnancy

Postoperative Diagnosis:
1 rupture let tubal ectopic pregnancy
2. Hemoperiteoneum
3-pelvic adhesions
Surgical Procedures:
1-exploratory laperotomy
2-partial salpingectomy
3-evauation of hempopatium
4-lisis of adhesions
Procedure in detail: The patient was prepped and draped within the ordinary manner and placed beneath sufficient general anesthesia, Pfannenstiel incision was preformed and carried via skin and subcutanous tissue, fascia and peritoneum. the paritenial cavity was entered. the hemoparituim was famous, and roughly 500 ml of blood was fast evacuated from the pelvic cavity, as had been large cloths, following this, the bowel was packed away the pelvic space with packing lapse. A retaining retractor was launched. The left fallopian tube was famous. A giant tubalectopic being pregnant was famous effecting approximately the distal half of the fallopian tube. Following this Heaney clamp was positioned and the mesosalpinx cell and one other curver clamp was paced in the proximal facet of the left fallopian tube beyond the realm of ectopic being pregnant. A patial salpiingectomy was preformed. eradicating the portion of the left fallopian tube containing the ectopic pregnancy.

Heaney clamps had been replaced with sutures with #1 micro. Hemostasis was checked once more and no bleeding was detected. Further evacuation of blood and blood clots was then preformed. the proper fallopian tube was famous to be coated with adhesions each tubular variatand tubal uterine The adhesions have been then sharply lysed releasing the right fallopian tube. Hemostasis was checked again. No bleeding was detected. Mild cirrhosis abrasion was noted was famous the place the area of the ectopic being pregnant was apparently connected to the bowel and never bleeding and was very superficial. hemostasis was checked and no bleeding was detected. The peritoneum was closed continuously was homeochinoc suture. The facsia was approximated was inntrupted with determine of eight stitches of micro and the pores and skin was approximated with staple gun. The patient tolerated the process nicely and left the operating room in satisfactory condition. All counts had been appropriate. Blood loss was estimated at 1000ml which was replaced with 2 untis of complete blood while in recovery. Rosemary Bumpbak, MD OBGYN

DIAGNOSTIC REPORT
Dr Donna Harrison dictation
Patient Name: Brenda C. Seggerman
Patient ID: 903321
Date of Admission: 3-27-2012
ER Physician: Alex McClure MD
Transvaginal ultrasound on 3-27-14
Patient History: Serve left pelvic ache rule out ectopic being pregnant. Pregnancy test is positive. Findings-transabdominal imaging demonstrates utures with small amount of fluid inside it Psudodecidual signal. There is a great amount of hemorrhage seen inside the left adnexa. no embryo is seen. The proper ovary is unremarkable Endovaginal examination was performed in searched of viable ectopic. One is seen with crown length with 1.3cm comparable to 7 weeks and four days. A large amount of free fluid is seen, esooudo gestuational sac is noted inside the uterus which is oblong. IMPRESSION: A left sided ectopic being pregnant is discovered with large amount of hemorrhage is noted and increasing into the cul-de-sac the hemorrhage measures 13x6x10cm. Dr. McClur and the emergency room was notified which notified the surgeon and is on her means, end of report Dr Harrison.

(Contiuned)

_________________________
Dr. Donna Harrison
NN:EF
D: 3/27/2012
T: 3/27/2012
Please send a replica of this report to
Rosemary Bumbak, MD OBGYN

DISCHARGE SUMMARY
Rosemary Bumbak, MD OBGYN
Patient Name : Brenda C. Seggerman
Patient ID: 903321
Date of Admission: 03/27/2012
Date of Discharge: 03/30/2012
Admitting Diagnosis: ectopic pregnancy
Surgical procedures:
1-expoloratory laparotomy
2-partioal salpingectomy
3-evacation of hemoparitoneum
4-lises of adhesions
Complication-blood loss requiring transfusion x2
History: This 35 12 months old white female Gravida three para 10121 had her final menstrual cycle in early January. Prior menstrual cycles had been common. She reported no contraceptives but not attempting being pregnant. Patient introduced to the emergency room complaining of vaginal bleeding with pain in lower pelvic area. ultrasound preformed in the emergency room showed a 13.eight cm left adnexall mass with optimistic cardiac exercise suitable with ectopic pregnancy. Hospital Course: On 3-27-2014 the affected person underwent exploratory laparotomy, left partial salpingectomy, evacuation of hemoparitoneum, and lyses of adhesions. Blood loss was approx 1000ml and was replaced with transfusion of 2 models of pink blood cells the blood kind was famous to be ORH adverse and RhoGAM was provided. The affected person was discharged on publish operative on day quantity three on after having a normal bowel movement she was discharged with complaints on no drugs. She understood her directions regarding comply with up, wound care and limitations Rosemary Bumbak ,MD OBGYN

PATHOLOGY REPORT
Berry J Lzano, dictation for
PATIENT NAME: Brenda C. Seggerman.
PATIENT ID: 903321
Date of Admission: 3/27/2012
Surgery: 3-27-2014
Admitting analysis: Ectopic pregnancy
Surgeon: Rosemary Bumback, MD OBGYN
Pathological Findings: 03-s-965 specimen received 3/27 specimen report 3-320 Procedure: left partial salpingectomy
The affected person has a ectopic being pregnant as confirmed by pelvic ultrasound. tissue obtained left fallopian tube. GROSS PATHOLOGY: desc examination of designated “left fallopian tube” reveals a left fallopian tube measuring 6cm in length and a pair of.three cm in regular width. Sectioning of the tube reveals a distending of the tube with blood clot and possible area tissue. reprehensive sections are locations in 1-c for embedding MICROSCOPIC: Microscopic examination was preformed