The Weedless Widow: A Jeff Talbot Mystery by Deborah Morgan
By Deborah Morgan
Jeff Talbot is becoming a member of his fishing acquaintances for his or her annual journey. he's additionally attempting to coordinate the directory and transportation of his newest haul of antiques. while he arrives on the Northwest Territory Bait and take on store for provides, he joins his fishing pal, the pass judgement on. jointly they locate their good friend and store proprietor, invoice Rhodes murdered.
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Extra info for The Weedless Widow: A Jeff Talbot Mystery
Possible causes of physiological vaginal discharge are: • • • • Vestibular gland secretions. Vaginal transudate. Cervical mucus. Residual menstrual fluid. Don’t forget to reassure the patient that vaginal discharge might simply be physiological, related to the menstrual cycle or to pregnancy. Pathological causes need to be excluded. The differential diagnoses of pathological vaginal discharge are shown in Fig. 1. The most common group is the infections. History to focus on the differential diagnosis of vaginal discharge The patient should be asked about the nature of the discharge.
2 refer to miscarriage. The term ‘miscarriage’ is used in preference to ‘abortion’ which many women will equate with a termination. History for Bleeding/Pain in Early Pregnancy Last menstrual period The first day of the last menstrual period (LMP) will allow you to calculate the gestation. This becomes important when interpreting early pregnancy scans. While an empty uterus on a scan at 7 weeks might indicate an ectopic pregnancy, a small gestation sac with no fetal pole is common at 5 weeks. However, it is important to establish whether the woman is sure of her dates and whether her cycle is regular; if not, the estimated gestation may be wrong.
Inflammation. Ulceration. Foreign bodies. Local tumours. Bimanual pelvic examination will reveal pelvic tumours. It might also elicit tenderness and cervical excitation, suggesting PID. 2 Investigations for vaginal discharge Investigation Cause of discharge • Microbiological swabs (vulval/high vaginal/ endocervical/urethral). • MSU specimen. • Cervical cytology/biopsy. • Endometrial sampling/hysteroscopy. • Pelvic ultrasound scan. • Laparoscopy. 2 shows the relevant investigations for vaginal discharge.