Divine Word Hospital

DEPARTMENT OF
OBSTETRICS AND GYNECOLOGY

SGD #6

Date of consult: December 19, 2020

AG, a 43-year old G3P3 (3003) came to the DWH Emergency Room for weakness. Patient is a
known diabetic and hypertensive with poor compliance to medications. She has no vices, no
history of contraceptive use. She had her menarche at 11 years old, with subsequent
menses occurring at regular monthly intervals soaking 2-3 pads per day with no
dysmenorrhea. Previous menses were not troublesome until 8 months prior to admission
when she began to experience heavier flow and prolonged menses soaking 4 to 5 baby
diapers a day lasting 7-10 days now associated with dysmenorrhea. No consult done until
this admission. She is on her 3 rd day of menses still with heavy flow soaking 4-5 baby diapers
a day with dysmenorrhea.

At the ER, BP 90/60 HR 104 RR 20 Temp 36.7C O2Sats 99%

Weight 82 kg Height 167 cm BMI 29

HEENT: pale palpebral conjunctivae, perioral pallor

Chest: tachycardic with normal rhythm, no murmur

Lungs: clear breath sounds

Abdomen: soft flabby, with no palpable masses

On speculum exam, vaginal walls

pink, there was a fleshy mass
occupying the vaginal vault and
prolapsing from the external os
covered with blood, with only a rim
of cervix seen around it

On internal examination, she had

normal external genitalia, parous
vagina, cervix smooth, dilated by the
said mass measuring 4 x 3 x 3 cm
smooth firm with regular contour
with a pedicle measuring 2 x 1 x 1
cm which seems to be attached at
the left isthmic area, corpus 8 weeks
size, no adnexal masses or
tenderness
 Divine Word Hospital
DEPARTMENT OF
OBSTETRICS AND GYNECOLOGY

On rectovaginal exam, good sphincter tone, intact rectal vault, (+) 7 x 6 x 6 cm firm irregular
extraluminal mass palpable at the cul de sac

Pregnancy test: Negative

Transvaginal Ultrasound:
Uterus measures 8.0 x 5 x 4.5 cm, anteverted, with regular contour
Cervix measures 3.2 x 3.0 cm anteriorly, and 3.1 x 2.9 cm posteriorly dilated by a
hyperechoic mass
There are multiple masses seen within the uterus
M1 measuring 4 x 3 x 3 cm prolapsed submucous
M2 measuring 7 x 6 x 6 cm posterior midcorpus, subserous Grade 6
M3 measuring 3 x 2 x 2 cm anterior midcorpus, intramural Grade 4
M4 measuring 2 x 1 x 1 cm anterofundal, intramural Grade 4
Normal ovaries
No adnexal masses seen
No free fluid in the sul de sac
 Divine Word Hospital
DEPARTMENT OF
OBSTETRICS AND GYNECOLOGY

Intraoperative Findings: