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Case presentation itp.

The document presents a detailed case study of a 22-year-old primigravida named Pooja Chidananda Patil, who experienced preterm premature rupture of membranes (PPROM) and immune thrombocytopenic purpura (ITP) during her pregnancy. The patient underwent an emergency cesarean section due to fetal distress, resulting in the birth of a healthy girl weighing 2.2 kg. Postoperative care included platelet transfusions and stabilization before discharge.

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anu.winnie
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2 views

Case presentation itp.

The document presents a detailed case study of a 22-year-old primigravida named Pooja Chidananda Patil, who experienced preterm premature rupture of membranes (PPROM) and immune thrombocytopenic purpura (ITP) during her pregnancy. The patient underwent an emergency cesarean section due to fetal distress, resulting in the birth of a healthy girl weighing 2.2 kg. Postoperative care included platelet transfusions and stabilization before discharge.

Uploaded by

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

By
Dr.ANUSHA (PG)
DR.MAHESHA(PG)
Demographic details:
Name: Pooja Chidananda patil

Age: 22 years

Sex: female

occupation: Housewife

Education: PUC

Husbands name- Chidananda patil

Occupation- BUSSINESS
• Religion: Hindu

• Address: Shigihalli K S, Marakatti (P), Bailahongala(T), Belagavi (D)

• Socioeconomic status: upper middle class( by modified BG prasad classification)

• DOA:10/6/22

• DOE-10/06/22

• LMP: 5/10/2021

• EDD: 12/07/2022

• POG: 35+3weeks
Chief Complaints:

• Primigravida With 8 and half months of amenorrhea


• c/o PV leak since 6am on 10/6/22
History of Present Pregnancy
• 1st trimester:

• Pregnancy detected by UPT at 2 months of amenorrhea, confirmed by scan


• Folic acid supplements taken
• No h/o excessive vomiting, increased frequency of micturition, fever with rashes.
• No h/o PV bleeding, PV spotting.
• No h/o exposure to radiation
• No h/o chronic drug usage.
• 2nd trimester:

• At 4 months of amenorrhea ,at regular ANC check up at KLE hospital , she was
diagnosed as chronic ITP and started on T.omnacortil 40mg 1-0-0 x 10days

• Anomaly scan done and said to be normal

• TT injection 2 doses taken

• Iron and calcium supplements taken from 5th month of amenorrhea

• GST done, said to be normal


• No h/o headache, blurring of vision, epigastric pain , vomiting.

• No h/o pain abdomen, PV bleeding, burning micturition.

• No h/o high sugar recordings.


• 3rd trimester:

• Continued to appreciate fetal movements.

• Patient was admitted to SDM on 28/5/22 i/v/o low platelet count and given
inj.methyl prednisolone 125mg BD x 3days f/b Prednisolone 50mg OD

• Iron and calcium supplements taken

• Growth scan done, said to be normal

• No h/o headache, blurring of vision, epigastric pain, nausea, vomiting

• No h/o pain abdomen, PV bleeding, PV leak, mucosal bleed or skin rashes


Obstetric history:

• Married life:1 year, NCM

• Obstetric score: primigravida

• Present pregnancy, spontaneous conception


Menstrual History:
• Age of Menarche:13 years

• Past Menstrual Cycle: Regular, 3-4 days flow, 30 days cycle, changes 2 pads/day,
no clots, no pain

• LMP: 5/10/2021

• EDD: 12/07/2022

• POG: 35+3weeks

• Scan EDD- 12/07/22 (NT Scan)


• Dating correct
Past History:
• Patient gives h/o admission to KLE hospital at 14 years of age i/v/o heavy
menstrual bleed , and was transfused PRBC and platelets i/v/o anemia (records
not available)

• Not a K/c/o Diabetes mellitus, hypertension, TB, asthma, epilepsy, thyroid or


cardiac disorders

• No h/o surgeries in the past

• No h/o allergy to any drugs


Family History:
• No significant family history

• No H/o bleeding disorders/ repeated blood transfusion in siblings/


parents
Personal History:

• Diet: Vegetarian
• Appetite: Normal
• Sleep: adequate
• Bowel and bladder: Normal and regular
• No h/o substance abuse
Provisional Diagnosis:
Primigravida with 35 weeks 3 days gestation with singleton
pregnancy with PPROM with ITP on treatment.
General physical examination:
• Patient is conscious, co-operative, well oriented to time, place and person.
• Moderately built and nourished

• On Examination:
• No pallor, cyanosis, icterus, clubbing, lymphadenopathy.
• No signs of petechia and ecchymosis
• B/L breast, thyroid, spine are normal
• Height-150cm
• Weight-54kg ,BMI-24kg/m2
• Pre pregnancy weight: 40kg, BMI-21.3kg/m2
• Vitals:
• Temperature: Afebrile
• PR: 78 bpm
• BP: 110/70 mmhg
• RR: 18 cpm
SYSTEMIC EXAMINATION:

• CVS: S1 S2 Heard, no murmurs

• RS: B/L normal vesicular breath sounds heard

• CNS: No focal neurologic deficits


• Per abdomen:
• Inspection:
• Abdomen is uniformly distended
• Umbilicus is central and inverted
• All quadrants move equally with respiration.
• Linea nigra and Striae gravidarum present.
• No scars, sinuses, engorged veins
• No discoloration seen on skin
• Palpation:
• Uterus 36 weeks size
• SFH: 30cm
• Abdominal girth: 83cm
• relaxed
• Estimated fetal weight :2.9KG
• Fundal Leopold maneuvers: broad, soft and non ballotable irregular
mass s/o breech
• Left lateral Leopold maneuvers : smooth, curved, resistant feel s/o back
• Right lateral Leopold maneuvers : multiple, knob like irregular structure
s/o limbs
• Pelvic Leopold maneuvers :
• 1st: hard, round, ballotable structure s/o head
• 2nd: hands converging-suggestive of unengaged head
• Liquor appears adequate
• Auscultation:

Fetal heart sound heard at left spinoumbilical line


142bpm, regular
Per vaginal Examination:

• Cervix-soft, posterior , 1 cm dilated

• Minimally effaced

• Membranes absent

• Clear leak present

• Vertex at -3 station

• Sacral promontory not easily reached

• Sacrum well curved


• Sacrosciatic notch admits 2 fingers

• B/L side walls parallel

• Interspinous distance adequate

• Subpubic arch well curved

• Pubic angle wide

• Inter tuberous distance admits 4 knuckles


Diagnosis:
• Primigravida with 35weeks 3days with singleton pregnancy with vertex
presentation with PPROM in latent labour with ITP.
Investigations:

PT 14.5 S

INR 1.10

APTT 31 S

LDH 180 U/L

CRP <0.5
• Blood group: O POSITIVE

• (23/4/2022) GST: 71mg/dl

• (23/4/2022) TSH: 1.12 mIU/ml

• (11/6/22)Peripheral smear: neutrophilic leucocytosis with severe


thrombocytopenia

• Culture sensitivity :
high vaginal swab : no growth

Urine culture and sensitivity : no growth


NT Scan(07/01/2022)
SLIUG of 12+6 weeks
Cardiac activity (+)
NT : 1.2 mm
EDD: 12/07/22

Anomaly Scan (26/02/2022)


SLIUG of 20weeks
Placenta : Fundo posterior
EDD:16/07/2022
Cervix length: 3.7cm
No obvious anomalies
Growth scan (28/05/2022)
SLIUG of 32+1weeks
Vertex presentation
Placenta fundoposterior
Liquor adequate
AFI- 10.1cm
EFW: 2.03 kgs

TAS:
SLIUG
Vertex
AFI:6cm
Outcome:
• 4 units of SDP transfused on 10/6/22 and 4 units of SDP transfused on
11/6/22 i/v/o thrombocytopenia

• Patient was given iv antibiotics

• Patient underwent Emergency LSCS on 11/06/2022 under spinal


anesthesia I/V/O Non reassuring NST with fetal distress.
Baby details:
• DOB: 11/06/2022
• TOB: 06: 21 AM
• Sex: GIRL
• Weight: 2.2 KG
• APGAR: 8/10, 9/10
• Baby cried immediately after birth, Baby shifted to mother side
Course in hospital:
• Patient was hemodynamically stable postoperatively
• Postoperatively platelet count:
• Haematology opinion was taken , was advised
tab.Prednisolone 20mg 2 ½ -0-0
T.Shelcal 1-0-1

• Patient was stabilised and was discharged.


Thankyou

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