Abdominal pain (Early Pregnancy) Uncomplicated Cystitis

Case: You are an HMO in the ED and your next patient is a 12-week GA pregnant lady complaining of nausea and
vomiting. This is her first pregnancy. No complications so far.
Task
a.
b.
c.

History (N/V with dull, nonspecific lower abdominal pain x 2 days; malaise; tolerate meals)
Physical examination (T:37.6, BP: 115/80; soft, tender in lower abdomen but not peritonitic signs; os is
blue, closed, no secretions or bleeding; free adnexas; fundus expected high according to gestational age;
nitrites ++++, leukocytes +++, no blood, protein and sugar)
Diagnosis and Management

History
- Was it a planned pregnancy? Congratulations. When did it start? Are you able to tolerate meals? Do you
feel tired? Do you have abdominal pain? What type of pain? Any discharges or bleeding? Fever?
Pregnancy checks? Did you have any tests done? Are you taking folic acid? Did they mention your blood
group?
- PMHx: any history of UTI;
- 5Ps: previous miscarriages; twin pregnancies?
Physical examination:
- General appearance: pallor, dehydration
- Vital signs: stable except temperature 37.5
- ENT/CVS/Lungs
- Abdomen: tenderness of lower abdomen
- Pelvic:
o Inspection of genitalia: bleeding, discharge;
o Speculum: no bleeding or discharge; os is close;
o Bimanual examination: adnexa are free; uterus is expected high
- Urine dipstick and BSL
Diagnosis and Management
- You have a condition called UTI most likely what we call cystitis. Do you know what it is? At this point, I
am happy to send you back home, but if the condition persists and you cannot tolerate foods or drinks,
fever, chills and pain in the back, then go to the ED.
- I will need to send your urine for culture and sensitivity and I am going to start you on amoxicillin 500 mg
TID or cephalexin 500 mg BID or nitrofurantoin 50mg QID. If pyelonephritis: ceftriaxone IV 1g OD.
- I will review you in 3 days and we will either continue your medication or change it according to the results
of your culture. I will prescribe paracetamol for the abdominal pain and metoclopramide for vomiting.