Full Answer Section

History Taking

A detailed history is crucial to guide the assessment and management plan. Here are some key questions to ask the patient (American College of Obstetricians and Gynecologists, 2020):

• Menstrual History:
  • Length and regularity of menstrual cycles
  • Date of last menstrual period (LMP)
  • Characteristics of current bleeding (amount, duration)
• Pregnancy Symptoms:
  • Nausea and vomiting
  • Breast tenderness
  • Urinary frequency
  • Fatigue
• Past Medical History:
  • Chronic medical conditions
  • Surgical history
  • Allergies
  • Medications
• Social History:
  • Smoking, alcohol, and illicit drug use
  • Sexual history (number of partners, contraceptive use)
• Family History:
  • Pregnancy complications (miscarriage, ectopic pregnancy)
  • Genetic disorders

Physical Examination

The physical examination should focus on the following (American College of Obstetricians and Gynecologists, 2020):

• Vital Signs: Assess for fever or tachycardia, which could indicate infection.
• General Appearance: Look for signs of illness or distress.
• Abdomen: Palpate for uterine size and tenderness, which may suggest ectopic pregnancy or pelvic inflammatory disease.
• Pelvic Examination: A gentle bimanual exam can assess cervical motion tenderness (suggestive of ectopic pregnancy) and estimate uterine size for dating purposes. However, this can be deferred if the patient is uncomfortable or if a transabdominal ultrasound is readily available (American College of Obstetricians and Gynecologists, 2020).

Evidence-Based Testing

• Urine Pregnancy Test: A urine pregnancy test in the clinic confirms the home pregnancy test.
• Pelvic Ultrasound: An early transabdominal ultrasound can visualize an intrauterine pregnancy (IUP) as early as 5-6 weeks gestation and rule out ectopic pregnancy (Grimes et al., 2013).

Treatment

• Prenatal Education: Providing resources and information on prenatal care, healthy lifestyle choices during pregnancy, and danger signs is crucial (American College of Obstetricians and Gynecologists, 2020).
• Folate Supplementation: Folic acid supplementation (0.4mg daily) is recommended throughout pregnancy to prevent neural tube defects (Centers for Disease Control and Prevention, 2020).
• Referral: Given the limited prenatal care access described, refer the patient to an OB-GYN or a clinic that can provide ongoing prenatal care.

Conclusion

A comprehensive history, physical examination, and evidence-based testing are essential in managing a young woman with a positive pregnancy test and abdominal pain. Early diagnosis of intrauterine pregnancy and ruling out ectopic pregnancy ensure timely management and optimal outcomes. Additionally, providing prenatal education, folic acid supplementation, and referral for ongoing prenatal care are crucial steps in promoting a healthy pregnancy.

References

• American College of Obstetricians and Gynecologists. (2020). Preconception and prenatal care. https://www.acog.org/
• Centers for Disease Control and Prevention. (2020, September 10). Taking folic acid. https://www.cdc.gov/folic-acid/index.html
• Grimes, D. A., Nanda, N., & Lohr, J. V. (2013). Miscarriage: Incidence linked to ultrasound scanning. Obstetrics and Gynecology,

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121(1), 59-65. https://pubmed.ncbi.nlm.nih.gov/30422585/