2. 24 year old Mrs. Ranjani, resident of Podanur, Coimbatore, belonging to middle socioeconomic status, studied
upto higher secondary class, a homemaker
G2 P1 L1, LMP 23.08.2021 and EDD on 30.05.2022, 34 +1 day GA
Regular cycles, sure of dates, booked and immunized, came for a routine AN checkup as she was advised to get a
tertiary care opinion in view of her Rh negative pregnancy.
3. Able to perceive fetal movements well
No c/o abdomen pain/draining pv/ bleeding pv/ discharge pv.
No h/o headache/vomiting/ visual disturbance/ swelling of legs
No h/o breathing difficulty/ palpitation
No h/o fever, cold, cough
No h/o trauma
4. PRESENT PREGNANCY
First trimester:
Pregnancy was confirmed following 10 days of missed periods by a urine pregnancy test at home.
Visited nearby PHC soon
Blood investigations- normal
Her blood group was B negative
Spouse B positive
Other blood tests and scans were said to be normal.
No h/o excessive vomiting, no h/o fever
Started on folic acid tablets, got first dose of vaccination.
No h/o radiation exposure.
No h/o blood transfusions/ drug intake
No h/o bleeding pv
5. SECOND TRIMESTER
Quickening felt after complete 5 months
Get second dose of vaccination
Started on calcium and iron tablets
Blood and urine investigations were done and said to be normal
Bp was recorded and said to be normal
Anomaly scan- apparently normal
No h/o abdomen pain/ bleeding pv/ draining pv/ fever
ICT was done at complete 6 months and said to be negative
No h/o Anti D administration
No h/o hypertensive disorders of pregnancy/ Gestational Diabetes
6. THIRD TRIMESTER
Continued to perceive movements as usual
Continued calcium and iron tablets
No c/o pain, draining, bleeding pv
Blood investigations were done and USG said to be normal.
BP was monitored and said to be normal.
No H/O hypertensive disorders of pregnancy/Gest Diabetes
No h/o anti D injections
7. MENSTRUAL HISTORY
Attained menarche at 12 years
Had regular cycles thereafter 3 to 5/ 28 to 30 cycles, moderate flow,
No h/o menstrual disturbances
Last menstrual period: 23.08.2021
Edd: 30.05.2022
8. MARITAL HISTORY
Married for 5 years, non consanguineous,
spouse BSc, Bank employee
No h/o contraceptive use
Blood group B positive
9. OBSTETRIC HISTORY
G2 P1 L1
First pregnancy:
Spontaneous conception after 6 months of marriage,
got regular antenatal checkups, booked and immunized, scans and blood tests were done periodically- normal, and
she was informed that her blood group- B negative.
No h/o hypertensive disorders of pregnancy, gestational diabetes,
No h/o blood transfusions, no h/o obstetric interventions antenatally.
Full term normal vaginal delivery at Theni GH, alive Boy baby ,B. wt: 2.9kg, cried soon after birth, breastfeeding
initiated soon after birth, uneventful.
Baby blood group was B positive.
Got Anti D injection on 2nd postnatal day, and discharged home on 3rd postnatal day.
Puerperium uneventful, no contraceptive method was adopted, breastfed upto 1 year (exclusively 5 months)
Now 3 years of age, normal milestones.
Present pregnancy: Booked and immunized at PHC, history elaborated already.
10. PAST HISTORY
Not a case of HT/DM/TB/BA/ Thyroid/ Heart disease/ Epilepsy
No H/o previous surgeries
No H/o previous hospitalisations
No h/o blood transfusions
No h/o long term drug intake
No h/o allergies
11. FAMILY HISTORY
Nuclear family, with 3 members
No h/o medical illnesses in family members
No h/o unexplained fetal deaths in family
No h/o congenital anomalies in family
No family h/o twins
No smokers in family
Blood group of pt’s mother: unaware
12. PERSONAL HISTORY
Takes veg and non veg diet
Bowel and bladder habits normal
Good appetite and good sleep
No addictive habits
13. DIET HISTORY
Takes a total of 2300 calories as against 2500 required
Takes 65 g of protein in her avg diet as against 70g as required
Has nuts, egg and greens in her diet
14. SUMMARY
24 year old G2 P1 L1, LCB 3 years, LMP on 23.08.2021, EDD on 30.05.2022, regular cycles, excellent dates,
booked and immunized, with no other comorbidities, Rh negative blood group with Rh incompatible
pregnancy.
16. Breasts, Spine, Thyroid, Gait- clinically normal
BP: 110/70mmHg measured in Right arm in sitting position
Pulse rate: 84/min, regular, normal volume and character, measured in right radial artery, no radioradial/
radiofemoral delay
Respiratory rate 16/min
Temp: normal
CVS: s1 S2 heard normally, no murmur
RS: NVBS heard
CNS clinically normal
17. OBSTETRIC EXAMINATION
Inspection:
Abdomen longitundinally enlarged, umbilicus flushed with surface,
Linea nigra, stria gravidarum +
No scars, sinuses, dilated veins
18. PALPATION
After correcting dextrorotation,
Fundal height corresponds to 34 to 36 weeks of gestation ( below xiphisternum)
SFH: 35cm
Leopold maneuvers:
Fundal grip: a broad smooth mass, not independently ballotable felt in fundus suggestive of breech
Lateral grip: a smooth uniform curved resistance on maternal left- suggesting spine, irregular knob like structures
towards right- suggesting limbs
First pelvic grip: a hard, round, regular, independently ballotable mass in lower pole- suggestive of head.
Second pelvic grip: Finding of first pelvic grip confirmed.
Liquor clinically appears adequate
20. SUMMARY
24 yr old G2 P1 L1, previous FTNVD, LCB 5 years, LMP 23.08.2021, EDD 30.05.2022, booked and immunized,
with a singleton fetus of 34 weeks 1 day gestation in cephalic presentation with good FHR, adequate liquor,
with Rh incompatible, non alloimmunised pregnancy.
21. DIAGNOSIS
24 year G2 P1 L1,, with a singleton fetus of 34 weeks 1 day GA in cephalic presentation with good FHR, with Rh
incompatible, non alloimmunised pregnancy for tertiary care opinion.
22. INVESTIGATIONS
CBC
HIV 1 and 2 for patient and spouse
HBsAg, VCTC
Urine R/E
ICT
USG obstetrics with fetal doppler
BPP/NST
