Southwestern University Medical

Center
Department of Obstetrics
and Gynecology

MORNING
General Data
•S.M.
•47-year-old
•G3P3 (3003)
•LMP: 04/25/2021
•PNMP: 03/15/2021
 Chief Complaint

Hypogastric pain
 History of Present Illness
•4 years PTA, patient went to an OB-GYN in
the province for IUD removal and an
incidental finding of a cervical mass was
seen upon examination. Patient was advised
to go on OB-GYN in the city for further
management. Patient consulted at VCMC
and a cervical mass biopsy was done and
revealed Adenocarcinoma in situ.
 History of Present Illness
•TVS was also requested and revealed a
heterogenous structure measuring 1.3 x 1.7 x
1.1 cm demonstrating abundance on color
flow mapping arising from the anterior
cervical stroma. Patient was then advised o
surgery but didn’t comply because of anxiety
and financial constraints. Patient was lost to
follow-up.
 History of Present Illness
•2 years PTA, patient noted a hypogastric mass about
10x10cm, non-tender, no associated symptoms.
Patient just tolerated the condition. No consult was
done.

•4 months PTA, patient noted heavy menstrual

bleeding for 1-2 weeks, used 4 fully soaked pads/day,
(+) blood clots, (-) abdominal pain. No consult done.
 History of Present Illness
• 3 months PTA, patient consulted with attending
physician for heavy menstrual bleeding, patient
was advised for a cervical biopsy.

• 3 weeks PTA, patient experienced crampy

hypogastric pain and consulted with another
physician at a clinic at Carcar since attending
physician wasn’t available at that time.
 History of Present Illness
•Plain CT scan of the whole abdomen was done
and revealed a well-defined large
pelvoabdominal soft tissue density contiguous
with a similar-appearing mass anterior to the
rectum about 15.9 x 11.7 x 9.8cm, likely uterine
and cervical in etiology. Patient took Celecoxib
200mg BID alternating with Tramadol and
Paracetamol BID.
 History of Present Illness
•Patient decides to be admitted in this
institution for further management for
persistence of hypogastric pain.
 Obstetrical History
OB Score: G3P3
(3003)
Gravidit Year Outcome/ MO AOG BW Hospital Complicati
y Sex D on
1 199 Female NSV Full AGA Home -
4 D term birth
2 199 Female NSV Full AGA Home -
6 D term birth
3 199 Male NSV Full AGA Home -
8 D term birth
 Menstrual History
•Menarche at 15 years old
•Interval: 28-30 days, regular
•Duration: 3-4 days
•Amount: 1 pad/day, fully soaked
•Symptoms: (+) occasional dysmenorrhea,
no intermenstrual bleeding
 Sexual History
•Coitarche at 16 years old
•Partner: 1
•Symptoms: (+) postcoital bleeding since
2017, (-) Dyspareunia
•Pap smear: done last 2016 – no result.
•STIs: None
 Contraceptive History
•IUD – from 1998 to 2006 (6 years)
from 2006-2017 (11 years)
•Withdrawal method
 Past Medical History
•No known allergies
•No known childhood illness
•No known comorbidities
•No maintenance medication
•No surgery was done
 Family History
MATERNAL SIDE PATERNAL SIDE
None Bronchial asthma
 Personal & Social History
•High school level
•Working as a contractual worker at DSWD
•Occasional alcoholic beverage drinker
•Non smoker
•No illicit drug use
 Review of Systems
• General: (+) weight loss, no fever, no anorexia
• Skin: no rashes, no lumps, no jaundice
• HEENT: no dizziness, no eye redness nor
blurred vision, no ear discharges nor tinnitus, no
hoarseness nor sore throat, no gingival bleeding
• Neck: no stiffness, lumps, nor neck pain
• Respiratory: no cough nor dyspnea
 Review of Systems
• Cardiovascular: no chest pain, no palpitations
• Gastrointestinal: no dysphagia, no heartburn,
no vomiting, no abdominal pain, no
constipation, no change in bowel habits
• Urinary: no difficulty in urination, no dysuria,
polyuria, and hematuria
• Genitalia: no discharges, no masses
 Review of Systems
• Musculoskeletal: no muscle or joint pain, no
deformities
• Neurologic: no changes in mood, attention or
speech
• Hematologic: no history of easy bruising
• Endocrine: no history of excessive sweating,
thirst or hunger, no history of polyuria
 Physical Examination
•General: Awake, •Vital signs:
conscious, coherent, oBP- 110/70 mmHg
not in respiratory oHR- 65 bpm
distress
oWeight: 54 kg. oRR- 20 cpm
oHeight: 5’ oTemp.- 36.8ºC
oBMI: 23.25 (normal) oO2Sat - 96%
 Physical Examination
•Skin: Pale
•HEENT: Anicteric sclerae, pale palpebral
conjunctiva, pale moist lips, (-)
lymphadnopathy
•C/L: Equal chest expansion, clear breath
sounds
 Physical Examination
•Heart: Distinct heart sound, Normal rate
and Regular rhythm, No murmurs

•Breast: symmetric, no discharges, no lumps

or masses, no tenderness
 Physical Examination
• Abdomen: non-distended, normoactive bowel
sounds, soft, (+) firm, movable mass at the
hypogastric area, 16 x 15 x 10cm, non-tender

• Speculum exam: (+) 6x6cm fungating cervical

mass with moderate vaginal bleeding
 Physical Examination
• BPE: fingers inserted with ease, sooth vaginal wall, (+)
fungating cervical mass, (+) pelvoabdominal mass, smooth and
well-circumscribed mass. No adnexal masses.

• RVE: tight sphincter tone, parametria free

• Inguinal: (-) lymphadenopathy

• Extremities: CRT <2sec, strong peripheral pulses

 Admitting Impression
1. Cervical Adenocarcinoma, Stage IB3
2. Leiomyoma uteri
3. Severe Anemia secondary to #1
4. G3P3 (3003)