Patient has complaints of missed periods (LMP) with amenorrhea for the last 4 months. On examination, cervical os is open with profuse discharge per vagina. State likely diagnosis and management list.

Likely diagnosis: Pregnancy

Management:
1. Confirm pregnancy with a urine or blood pregnancy test.
2. Provide counseling on options for pregnancy continuation or termination.
3. Refer to an obstetrician/gynecologist for further evaluation and prenatal care if the patient chooses to continue the pregnancy.
4. Offer contraceptive counseling and options for future family planning.

Likely Diagnosis: Incomplete abortion

Management List:

- Emergency measures:
- Ensure airway, breathing, and circulation (ABCs).
- Establish intravenous (IV) access for fluid resuscitation and medication administration.
- Monitor vital signs (pulse, blood pressure, temperature).
- Control bleeding with IV fluids or blood transfusion if necessary.

- Medical management:
- Uterotonic agents: Administer oxytocin or misoprostol to stimulate uterine contractions and expel the remaining fetal tissue.
- Antibiotic prophylaxis: Prescribe antibiotics to prevent infection.
- Anti-D immunoglobulin: Administer anti-D immunoglobulin to Rh-negative women to prevent Rh sensitization if fetal tissue is present.

- Surgical management:
- Manual vacuum aspiration (MVA): Suction out the remaining fetal tissue using a suction curette under local anesthesia.
- Cervical dilation and evacuation (D&E): Dilate the cervix and remove the fetal tissue using forceps or curettes.

- Follow-up:
- Schedule a follow-up appointment to ensure complete evacuation and assess recovery.
- Order lab tests to monitor hemoglobin levels and pregnancy hormone levels.
- Provide counseling and support to the patient.