Khukhumoni Bibi, a 29-year-old pregnant woman, presented with weakness, dizziness and oral lesions. She had her first prenatal visit at 12 weeks, and testing at 16 weeks found hemoglobin of 6.7 g/dL, but she did not take therapeutic iron. By 32 weeks, her hemoglobin had dropped to 5.9 g/dL. Examination found pallor but no other abnormalities. Testing confirmed severe iron deficiency anemia at 32 weeks of gestation.
3. PATIENT PROFILE
Name – Khukumoni Bibi
Age – 29 years
Religion – muslim
occupation - housewife
Occupation of husband- Tailor
Address- Badra tala ,Nadial , South 24 Parganas
Duration of marriage- 8years
4. Parity – G2 P1+0+0+1
Last menstraul period – 26/12/2021
Expected date of delivery – 03/10/2022
Period of gestation –35 + 1
Date of admission – 19/08/2022
Date of examination – 29/08/2022
6. HISTORY OF PRESENTING ILLNESS
Patient was not a booked case of any health facility
Patient had her 1st antenatal visit at 12 weeks of
gestation at a private clinic
She was started iron folic acid calcium
supplementation
She had her 1st antenatal investigations at 16
weeks of gestation which reveled low haemoglobin
6.4g/dl
Patient revealed she recived iron tablets once daily
7. Further patient complained of oral lesion , and loss
of apetite
Later she also developed giddiness, general
weakness , lethargy.
No history of shortness of breath, palpitation
No history of syncopal attack
No bleeding pv
No per rectal bleeding
No perianal itching
8. Despite iron supplementation hb did not improve .
So she was referred to any state medical hospital
with Hb-5.9g/dL
Patient was admitted via emergency Room at
SSKMH
On admission, her USG for Fetoplacental profile
and CTG was done and found to be normal
Routines including blood for Complete Blood
Count,Red blood cell indices,serum ferritin,Hb
electrophoresis &serology were sent
High risk counselling done
9. HISTORY OF PRESENT PREGNANCY
Pregnancy was Unplanned
Confirmed by urine pregnancy test
Pt was immunised ;received 2 doses of tetanus
toxoid
All routine routine antenatal investigations done
Hb level on 1st check up at 12 weeks was 6.7g/dl
She received only prophylactic iron dose
Quickening at 5months of gestation
Fetal movement was well appreciated
Only one usg was done at 33 weeks
10. OBSTETRIC HISTORY
P1-
Term Baby, live and healthy girl child 3.2kg birth
weight
Pregnancy, labour and puerperium was uneventful
Spontaneous vaginal delivery
11. MENSTRUAL HISTORY
Attained Menarche at 12 yrs of age
Regular cycles with normal flow for 5-7 dya in a 28-
32 days cycle
No history of dysmennorhoea
No history of menorrhagia
Last Menstrual Period- 26/12/2021
Expected Date of Delivery(Naegele’s formula)
3/10/22
12. PAST MEDICAL HISTORY
No history of tuberculosis,
heart disease,urinary tract infection
hypothyroidism or any other illness.
There is past history of hookworm infestations for
which she took medications
No history of lood transfusion
14. FAMILY HISTORY
She is youngest of 4 siblings
Family history shows no history repeated blood
transfusion
No history of tuberculosis, blood dyscrasias , nown
hereditary disease
No history of consanguinous marriage
15. PERSONAL HISTORY
history of loss of appetite
Normal sleeping pattern
Normal bowel and bladder habits
Non smoker
Non –alcoholic
No known drug allergy
No history of previous blood transfusion
18. GENERAL PHYSICAL EXAMINATION
Patient is alert, conscious,co-operative and comfortably
lying on the bed
She is of normal built and moderately nourished
Her BMI-
Vitals: BP- 120/74 mm Hg,Pulse-88bpm,regular,normal
volume,all peripheral pulses are equally palpable
Respiratory rate-18 breath per minute
Temperature- 37degree centigrate
19. No jaundice
Pallor present over lower palpebral conjunctiva ,
nailbeds,dorsum of tongue
Glossitis + , Stomatitis +, Cheilitis- noted
No obvious neck swelling,
No cervical lymphadenopathy
No engorged neck veins
Breast- No lumps ,no nipple discharge
Lower limbs- No pedal edema
20. ABDOMINAL EXAMINATION
INSPECTION
Abdomen uniformly distended and longutinally
ovoid.
Linea nigra,stria gravidum are present
Umbilicus centrally placed and inverted
No scar mark or evidence of skin infection seen
PALPATION
Clinical fundal height~34 weeks
Symphysiofundal height corresponding to
34 weeks
21. FUNDAL GRIP:
Soft,Broad,Non-Ballotable fetal buttock
LATERAL GRIPS: Curved broad surface –fetal back on
maternal right side
Irregular knob like structure felt on maternal left side =
fetal limbs
PAWLICK GRIP :Hard globular ballotable mass
PELVIC GRIP: Head not engaged
AUSCULTATION
Foetal heart sound heard on maternal right spino
umbilical line
22. VAGINAL EXAMINATION
Patient was not in labour
There was no vulval edema
No vaginal discharge
Other systemic examination
-nothing significant
26. CASE SUMMARY
Mrs. Khukhumoni, 29 year old second gravida
presented to the Emergency Room with complain of
generalised weakness, giddiness,lassitude and oral
lesions.
She was an unbooked case and and she had her
1st antenatal check up at 12 weeks of gestation
She did her 1st antenatal investigations at 16 weeks
of gestation which revealed hb to be 6.7 g/dl
However , she did not consume therapueutic dose
of iron then
27. She developed oral lesions viz. stomatitis, glossitis
It led to loss of aprtite
Further she developed general weakness ,
lassitude, giddiness
At 32 weeks of gestation , she visited a private
practitioner . Hb reveled to be 5.9g/dl
She was referred to higher state genera/ medical
college and hospital
She presented at SSKMH
28. On examination pallor was present with no signs of
cardiac failure .her SFH was 32cm ,single fetus
cephalic presentation FHS 132beats per minute
regular
Routines along with peripheral blood film and iron
profile was done.