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Case Presentation: Melwin Maben Final Year, Hims Hassan

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37 views

Case Presentation: Melwin Maben Final Year, Hims Hassan

Uploaded by

akoradiya90900
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CASE PRESENTATION

MELWIN MABEN
FINAL YEAR, HIMS HASSAN
Name: Mrs. XYZ
Age: 24 years
Sex: Female
Address: Chikkamagalur
Occupation: Housewife
Education: 10th Std.
Husband’s Details: Mr. ABC, 27 years, Labourer, Educated
up to 7th Std.
Socioeconomic status: Class 4 of Modified BG Prasad
Classification
DOA: 05th March 2020
DOE: 07th March 2020
LMP: 20th June 2019
EDD: 27th March 2020
Period of Gestation: 37 weeks
Obstetric Score: G1P0L0A0
CHIEF COMPLAINTS
H/o Amenorrhea since 8 ½ months
C/o Bleeding per vagina 2 days ago
HISTORY OF PRESENTING
ILLNESS
Patient was apparently alright 2 days. Then she
developed bleeding per vagina which was
sudden in onset, which completely soaks 1 pad,
associated with bright red coloured blood. It
stopped spontaneously.
The fetal movements are well percieved
• No H/o pain in abdomen associated with
bleeding
• No H/o excessive fatiguability, palpitations
• No H/o blurring of vision or pedal edema
• No H/o Trauma
• No H/o Leaking per Vagina
OBSTETRIC HISTORY
Married Life: 4 years
Non Consanguineous marriage
Obstetric Score: G1P0L0A0
HISTORY OF PRESENT PREGNANCY
First Trimester:
-Spontaneous Conception
-Pregnancy was confirmed after 1 ½ months of missed period by UPT and
she was a booked case at HIMS.
-3 ANC visits completed
-Folic Acid tablets were taken
-First Trimester (Dating Scan) was done and was found normal and
corresponding to gestational age
No h/o burning micturition.
No h/o fever with rashes, excessive vomiting.
No h/o spotting or bleeding per vagina.
No h/o pain abdomen.
No h/o exposure to radiation and drug intake.
• Second Trimester:
-Quickening was felt at 5 ½ months of gestation
-Second Trimester(Anomaly Scan) was done and no anomalies
were found.
-Iron and Calcium Tablets were taken
-Two doses of TD vaccine taken
-No History of fever with rashes
-No History of any drug intake or radiation exposure
-No History of Per vaginal bleed
-No H/o Pedal edema or headache
-No H/o Raised BP Recording or Raised Blood Sugar
recording
• Third Trimester:
-Fetal movements are well perceived
-Iron and Calcium tablets taken
-Growth scan done at 32 weeks and showed
normal development
-Weight gain in pregnacy-12 kg
MENSTRUAL HISTORY
Menarche: 13 years
Past cycles:
28 days cycle 3-4 days of flow
2-3 pads/day No H/o Dysmenorrhea,
passage of clots

LMP: 20th June 2019


EDD: 27th March 2020
CONTRACEPTIVE HISTORY
Barrier Method (Condoms) were used as
contraception
PAST HISTORY
Not a known case of Diabetes mellitus,
Hypertension, Epilepsy, Asthma, TB,
Thyroid Disorders.
No H/o Surgeries in the past
No H/o Previous Blood Transfusions
FAMILY HISTORY
-No history bleeding disorder in the family.
-No history of children with chromosomal
anomaly /birth defect.
-No history of twining in the family.
PERSONAL HISTORY
• Diet: Mixed
• Appetite: Normal
• Sleep: Undisturbed
• Bowel and Bladder: Normal and
regular
• No H/o any addictions
SUMMARY
A 24 year lady with an Obstetric Score of
G1P0L0A0 with 8 ½ months of amenorrhea
comes with one episode painless bleeding per
vagina 2 days ago. It was sudden in onset. Fetal
movements are well percieved.
GENERAL PHYSICAL
•
EXAMINATION
Here is a young lady who is moderately built
and nourished. She is conscious, cooperative
and well oriented to time, place and person.
• Weight – 67 kg
• Height – 158 cm
• BMI – 26.91 kg/m2
• Pallor, Icterus, Clubbing, Cyanosis,
Lymphadenopathy, Edema: Absent
• Breast, Spine, Thyroid: Normal
VITALS
• Pulse rate – 76 beats/min, regular rhythm,
normal volume, normal character
• Blood pressure – 120/80 mmHg. Taken
from left hand in sitting position
• Respiratory rate – 16 cycles/min, thoraco-
abdominal type
• Temperature – 98.6 F
PER ABDOMEN
EXAMINATION
• INSPECTION
Shape of the abdomen- Uniformly Distended
Flanks: Full
Umbilicus is central and everted.
Linea nigra and Stria gravidarum: Present.
No scars, sinuses or dilated veins can be seen.
Hernial orifices are intact.
• PALPATION
No local rise of temperature or tenderness.
Uterus is relaxed
Abdominal girth: 99 cm, at the level of
umbilicus.
Fundal height: 36 weeks, corresponds to
gestational age.
Symphysio-fundal height: 36 cm,
corresponds to gestational age.
OBSTETRIC GRIPS :
Fundal grip : Broad, soft, irregular mass suggestive
of breech.
Right Lateral grip : Uniform, continuous curved
resistance suggestive of spine.
Left lateral grip : Multiple knob like structures
suggestive of limbs.
1st Pelvic grip : Hard, ballotable mass suggestive of
fetal head
2nd Pelvic grip : Fingers are converging.
AUSCULTATION :
FHS heard along the right spinoumbilical line,
rate - 140/min
SYSTEMIC EXAMINATION
Cardiovascular system
S1, S2 sounds heard, no murmurs heard

Respiratory system
Normal vesicular sounds heard
No added sounds

Central nervous system


No focal neurological deficit
SUMMARY
• A 24 year lady with an Obstetric Score of G1P0L0A0
with 8 ½ months of amenorrhea comes with one
episode painless bleeding per vagina 2 days ago. It
was sudden in onset. Fetal movements are well
percieved.
• Her vitals are normal and on per-abdominal
examination, the symphysio-fundal height
corresponds to the period of gestation. A single
live fetus is palpated with hard ballotable mass
on 1st Pelvic Grip suggestive of Cephalic
Presentation. The fetal heart sounds are
normal.
PROVISIONAL DIAGNOSIS
A 29 year old lady with obstetric index
G0P0L0A0 with 37 weeks of gestation
with live single intrauterine pregnancy
with Cephalic Presentation with
Antepartum Haemorrhage under
evaluation.
MCQ 1-All of the following are features
of Placenta Previa except:
A) Painless, recurrent bleeding
B) Can be revealed or concealed type of
bleeding
C) Height of Uterus is proprtional to gestational
age
D) Uterus feels soft and relaxed
• Answer: B
• Bleeding is always revealed in Placenta Previa
• Ref: DC Dutta
2) Identify the Condition and name the
cause for the same
• Ans: Couvelaire Uterus
• In concealed variety of Abruptio Placenta the
blood enters the myometrium, uterus appears
bluish or wine coloured.

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