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19 views

Osmecon Final

Uploaded by

Deekshitha Madduri
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Case presentation

Deekshitha Madduri
SVIMS -Sri Padmavathi Medical College
Department of Obstertics & Gynaecology
Chief Complaints Date of examination : 31/07/2022

A 21 year old , named Bhavya , Housewife, who is a graduate hailing from


Tirupati, belonging to High Socioeconomic class according to modified BG
Prasad Classification, is primigravida with 8 months of amenorrhea .

LMP - 15 th December 2021


EDD -22nd September 2022

Came with the chief complaint of on and off abdominal pain since 1 day .
History Of Presenting Illness
She was apparently asymptomatic 1day back
Present Illness started as pain in the lower abdomen , which was
● Insidious in onset
● Gradually Progressive in nature
● Radiating to thigh and lower back
● Not associated with any bleeding per vaginum , blood stained mucus
discharge or leaking PV .
Similar history 2 weeks before and patient was put on,

2 doses of inj . Betamethasone


Tab.Duvadilan(10mg) BD
Present Obstetrics History

● She conceived spontaneously


● Primigravida with 8 months of amenorrhea
● LMP : 15 th December 2021
● EDD : 22nd September 2022
● She is a booked case , Immunised .
● Period of Gestation : 32 Weeks and 3 days
1st Trimester

● Pregnancy was detected by urinary pregnancy test at home after


1month of amenorrhea .
● Pregnancy was confirmed by scan done at hospital in 2nd month
● H/o Nausea , vomiting , morning sickness .
● H/o increased frequency of micturition
● No H/o of Excessive vomiting
● No H/o of dizziness, fatigability , palpitations.
● H/o Folic acid intake from 2nd month
● TT injection - 1st dose at 3rd month
● No H/o fever with rash.
● No H/o teratogenic drug intake , radiation exposure , PV bleeding .
● Dating scan done at 2nd month .

INVESTIGATIONS DONE :
1. Complete Blood Count
2. Blood grouping
3. Viral markers - HIV , HBV
Normal
4. Glucose challenge test
5. Urine routine
6. Thyroid profile
2nd Trimester
● She continued regular antenatal visits
● Quickening felt at 5 th month
● H/o Pedal Edema - Relieved on taking rest
● No H/o Headache ,Blurring of vision , Epigastric pain
● No H/o polyuria, polydypsia
● No H/o PV bleeding
● Fe & Ca intake from 4 th month
● TT Injection - 2nd dose at 5th month
● TIFFA Scan done at 5th month - no abnormalities were detected
● Glucose Challenge test done at 2nd trimester is normal
3rd Trimester
● Continue to perceive fetal movements
● No H/o Headache , Blurred vision , pedal edema
● No H/o polyuria , polydypsia
● No H/o PV bleeding
● Continued Fe & Ca intake
● Growth scan done at 7 th month
● H/o sudden onset of labour pain at 30th week for which she was treated.
● Since 1 day she is suffering from severe lower abdominal pain for which she was
admitted to OBG ward and proceeded to delivery.
Menstrual History

● Regular cycles
● LMP - 15 th December 2021
● EDD -22nd September 2022
Marital History

● Name of Husband : T. Dilip


● Age at marriage -20 years
● Marriage duration - 1 ½ years
● Consanguineous marriage ( 3rd degree)
● Spontaneous conception after 10 months of marriage
Past History
● Not a known case of Hypertension , Diabetes Mellitus ,Asthma , Epilepsy , CAD ,
CVA ,CKD
● No H/o TB , Thyroid disorders , previous surgeries , blood transfusions , previous
hospitalisation.
Personal history
● She takes both vegetarian & Non Vegetarian diet .
● H/o weight gain of 11kgs
Pre pregnancy weight - 48 kgs
Present weight -59 kgs
● No H/o sleep disturbances
● Normal appetite , Bowel , Bladder movements
● No H/o any addictions .

Family History
● No significant family history
General physical examination
She is moderately built , well nourished , conscious , coherent , cooperative ,
well oriented to date , time, place .

● Pallor
● Icterus
● Cyanosis
● Clubbing Absent
● Lymphadenopathy
● Edema

● Breast
● Spine Normal
● Thyroid
Vitals

Temperature : Afebrile
Pulse : 76 bpm , regular rhythm , normal volume & character
Respiratory rate : 16 cycles / min , Thoracoabdominal
BP : 120 / 80 mm Hg , left arm , sitting position

Anthropometry

Pre pregnancy : Pregnancy :


Height : 5 feet 3 inches Height : 5 feet 3 inches
Weight : 48 kg Weight : 59 kgs
BMI : 18.6 kg/m2
CVS : S1, S2 are heard Systemic examination
No murmurs are heard

RS Normal vesicular breath sounds are heard

CNS : No focal neurological deficit

Per abdomen :
( consent was taken , with adequate privacy she is undressed from xiphi sternum to mid
thigh and is asked to flex her knees ,then she is examined under adequate light )
Inspection :
● Abdomen is longitudinally ovoid
● Linea Nigra , striae gravidarum are seen
● Umbilicus is centrally placed , everted .
● Hernial orifices are intact
● No scars , discharging sinuses are seen
Palpation :
Fundal height : 32 cms
(By standing on rt side of her , with ulnar border of left hand , palpation is done from xiphi
sternum to feel the resistance and is felt as 32 weeks size )
● 32 weeks size

● Flanks are not full and correspond to period of gestation


Leopold Maneuvers
Fundal grip :
( By standing on right side , facing her head, fundus is palpated with both hands )
● Felt as broad , soft , irregular not independently ballotable inferring breech
occupying fundus .
Lateral grip :
● Right : Multiple small nodules are felt inferring limb buds
● Left : Uniform curvilinear resistance is felt inferring spine
Pawlick grip : Hard , round , independently ballotable part is felt inferring head
Pelvic grip : Hands diverge inferring Head engaged .
Auscultation : Fetal Heart sounds are heard on left spino-umbilical line. FHR : 169 bpm
Per speculum examination :
● No leaking PV
Per Vaginal examination
● Cervical dilation : 8cm
● Fully Effaced
● Bulging Membranes present
Provisional diagnosis

Bhavya , A 21 year old primigravida with 32 weeks 3 days gestation, with a single live
foetus in cephalic presentation in active preterm labor .
Management - Investigations ( Antenatal )

TIFFA Scan - 19th week- normal

● FHR : 169 bpm, four chamber heart visualised ,


situs solitus, outflow tracts are normal
● Nuchal thickness 3.8 mm
● Placenta : posterior upper uterine segment ,
grade -1 maturity .
● Amniotic fluid : adequate
● Approx fetal weight : 295 g +/- 43 g
● Cervix length 3.3 cms, internal os is closed.
Hematogram studies
Treatment

Vaginal delivery with left mediolateral episiotomy was done .


A male live baby of weight 2.23 kg with two tight loops of cord around neck was
delivered on 31/ 07/22 , 10.51 AM .

Fetal details :
● Cried immediately after birth .
● Non - meconium stained liquor
● Weight - 2230 g
● Length - 44 cm
● Head circumference - 32 cm
Vitals -
● Heart rate : 140 bpm
● Respiratory rate : 58 cycles / min
APGAR Score :

1 min after birth : 6/10


5 min after birth : 7/10
10 min after birth : 8/10
Day -1
● BCG , OPV , Hepatitis B vaccines are given

Day -4 :
● 2nd hourly breastfeeding and top fed on demand
● H/o burping
● Accepting feeds well
● Baby slept well
● Cry , Activity , Reflexes - normal

Day - 5
● Baby was diagnosed with neonatal jaundice and
treated with phototherapy
Condition of mother post delivery

Vitals :
● Temperature : afebrile
● Pulse : 94 bpm
● BP : 110/70 mm Hg
● RR : 16 cycles / min

Per abdomen : soft , uterus contracted , retracted well .


Local examination :
● Episiotomy wound approximated well .
● Lochia healthy .

● Urine - passed
Summary
Bhavya , A 21 year old primigravida with LMP 15 th December 2021 , EDD 22nd
September 2022 , presented with pain abdomen at 32 weeks of gestation . she is in
active labor and vaginal delivery with left medio lateral episiotomy was done . She
gave birth to a male live baby of weight 2.23 kg with 2 tight loops of cord around
neck , on 31/7/22 , 10.51 AM she had a similar history at 30 weeks of gestation for
which 2 doses of inj Betamethasone , Tab Duvadilan (10 mg ) BD were given to
maintain the pregnancy .
Thank you
Guided by
Dr . J .Malathi Mam
HOD , Dept of OBS & GYN
SVIMS -SPMC (W)

Dr . Shruti Bhatia Mam,


Assistant professor ,Dept of OBS & GYN
SVIMS - SPMC (w)

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