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Case Presentation: DR Anika Tasnim Probha Intern Doctor Gynae & Obs Unit 1 Jashore Medical College Hospital

Mrs. Shirina, a 32-year-old housewife, presented with 16 weeks of amenorrhea, 15 days of scanty vaginal bleeding, and 7 days of lower abdominal pain. Examination found an enlarged, tender abdomen with no fetal heartbeat. Ultrasound confirmed a missed abortion at 16 weeks and 6 days. She was initially treated with antibiotics and pain medications. When medical and mechanical methods failed to expel the fetus, she underwent a D&C procedure with suction evacuation under spinal anesthesia to complete the missed abortion.

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92 views

Case Presentation: DR Anika Tasnim Probha Intern Doctor Gynae & Obs Unit 1 Jashore Medical College Hospital

Mrs. Shirina, a 32-year-old housewife, presented with 16 weeks of amenorrhea, 15 days of scanty vaginal bleeding, and 7 days of lower abdominal pain. Examination found an enlarged, tender abdomen with no fetal heartbeat. Ultrasound confirmed a missed abortion at 16 weeks and 6 days. She was initially treated with antibiotics and pain medications. When medical and mechanical methods failed to expel the fetus, she underwent a D&C procedure with suction evacuation under spinal anesthesia to complete the missed abortion.

Uploaded by

Doctor Jit
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We take content rights seriously. If you suspect this is your content, claim it here.
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CASE PRESENTATION

DR ANIKA TASNIM PROBHA


INTERN DOCTOR
GYNAE & OBS UNIT 1
JASHORE MEDICAL COLLEGE
HOSPITAL
Particulars of The Patient
 Name: Mrs Shirina
 Age: 32 years old
 Marital status : Married
 Husband’s name: Sentu Mia
 Religion: Islam
 Occupation: Housewife
 Address: Mirzapur,Moheshpur,Jhenaidah
Ward no: G/W
Bed no: 3
Reg no: 36998/78
Date of admission: 19.7.22
Date of examination: 20.7.22
Chief complaints

History of Amenorrhea for 16 weeks


History of P/V bleeding for 15 days
History of Lower abdominal pain for 7
days
History of present Illness
According to the statement of the patient she was
amenorrheic for 16 weeks.She was having per
vaginal bleeding, which was irregular and scanty for 15 days.
There was no history of passing blood clot. She also
complained of lower abdominal pain which was cramping in
nature for 7 days.
With the complaints she went to Chowgacha Health
Complex. They referred to JMCH for better
management.
There is no history of fever, foul smelling per
vaginal discharge
Her bowel and bladder habits were normal.
History of past illness

She gave history of UTI 06 months back.


She has no H/O of Hypertension, Diabetes mellitus,
Bronchial Asthma.
Obstetric History
Married for: 15 years
Para: 4 (1 NVD+ 3 C/S) – 1(IUD)
Gravida : 5
ALC: 4 years
Gynecological history
 Age of menarche : 13 years
 Menstrual period: Irregular
 Menstrual cycle : Irregular
 Menstrual flow: Average
 LMP: ?
 EDD:?
Contraceptive History

She didn’t give any contraceptive history


Drug History

She took some medication for UTI but


couldn’t mention the name
Family History

Nothing contributory
Personal History
She is non smoker, non alcoholic. She doesn’t
take
beetle nut.
Socio-economic History
She belongs from a lower middle class family.
Immunization History

She is immunized as per EPI schedule


General Examination
 Appearance : Looking ill
 Body Built: Average
 Nutritional status: Average
 Cooperation : Cooperative
 Anaemia: Mild
 Jaundice: Absent
 Oedema: Absent
 Dehydration : Absent
 Pulse: 76 b/min
 BP: 110/70 mmhg
 Respiratory rate: 16/ min
 Temperature: 99°F
Per abdominal Examination
Inspection:
Abdomen was distended. Flank was full. Umbilicus
was centrally placed.
Linea nigra and striae gravida were present . There
was scar mark of previous C/S
Palpation:

Abdomen was tender in hypogastric, left and right iliac


region. Symphysio-fundal height was less than the period
of gestation. No fetal parts were palpable. No fetal
movement was present. Liver, spleen were palpable.
Kidney was not ballotable .
Percussion:
Percussion note was tympanic.
Auscultation:
There was no audible fetal heart sound
Bowel sound was present .
Other systemic Examination

Respiratory system examination:


Normal breath sound .Lung field was clear. No audible wheeze or crackle
was found

Cardiovascular system examination :


1st and 2nd heart sounds were audible. No other abnormities were found.
Nervous system examination :
No neurological deficit was found
Salient Feature :
Mrs. Shirina,32 years old, Married, Muslim, Housewife, non diabetic,
normotensive,5th gravida, Para 4 (1 NVD+3 C/S)- 1(IUD),hailing
from Mirazapur, Maheshpur, Jhenaidah admitted to JMCH with the
complaints of amenorrhea for 16wks; scanty irregular P/V bleeding
for 15days & cramping lower abdominal pain for a week. She gave no H/O
passing blood clot, fever & foul smelling discharge. Her bowel & bladder
were normal. She didn’t take anything for contraception.
She gave H/O UTI 5 months back for which she took some medication
But couldn’t mention the name.
On general examination I found the patient looking ill, average , built
& nutritional status and cooperative. She was mildly anemic, non
icteric, non oedematous, non dehydrated. During examination her
pulse was 76 b/min; BP 110/70 mmhg, R/R 16/min. On P/A/E I found
the abdomen distended, full flank, tender, soft. There were linea nigra,
striae gravida & scar mark of previous C/S .Symphysio-fundal height
didn’t correspond to the period of gestation. There were no fetal
movement, palpable fetal part & audible FHS. Other systemic
examination revealed no abnormalities.
Provisional Diagnosis

Missed Abortion
Differential Diagnosis

 Septic Abortion
 Incomplete Abortion
Initial Treatment

 Diet: Normal
 Tab. Cefuroxime 500mg 12 hourly
 Tab. Metronidazole 400mg 8 hourly
 Tab. Tiemonium Methylsulphate 500 mg 8 hourly
 Cap. Esomeprazole 20mg 12 hourly
 Tab Tranexamic Acid 500mg 8 hourly
Investigation
Confirmatory investigation:
Ultrasonography of pregnancy profile:
Uterus: gravid, contains single dead fetus
Fetus:
 Presentation: cephalic
 Fetal movement: Absent
 Cardiac pulsation: Absent
 Fetal heart rate: Absent
BPD: 35.00 mm
FL: 22.6 mm
F-maturity: 16 wks 06 days of gestation
Amniotic fluid: 14 cm
Placenta: Posterior fundal away from int. os
Maturity: Grade 0

Impression: Missed abortion


Associated investigation :
 Blood grouping: O (+ve)
 HB% : 10.5 mg/dl
 HbsAg: Negative
 BT: 03 min 10 sec
 CT: 06 min 20 sec
 Urine R/M/E : no abnormalities detected
Confirmatory Diagnosis :

MISSED ABORTION
Management Plan:

Expectant management:
We kept the patient under observation for 3 days for spontaneous
expulsion

Medical management:
For dilation of cervix prostaglandin analogue MISOPROSTOL was
used
From 22.7.22 we added Tab. Cytomis 200mcg 1/4th sublingually
6 hourly upto 24hr
Mechanical management:
To speed up the procedure on 23.7.22 we add intracervical
catheterization with 40 c/c distilled water.

Surgical management:
When above procedures failed to expel the product of conception ;with
written consent D&C was done under SAB.
Thank you !

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