Case presentation

1. CASE PRESENTATION
BY DR SARAH SIDDIQUI

2. BIODATA
28 yrs. old female, primary gravida, has NKCM came to LR on 31-12-
2022 at 6:30pm with complain of
• Gestational amenorrhea– for 9 months
• Lower abdominal pain – for 12 hrs.

3. HISTORY OF CUURENT PREGNSNCY AND
PRESENTING COMPLAIN
According to patient she was in USOH 9 months back then she has missed
her periods. She has done her urine pregnancy test that was positive. Her
first ultrasound was done on 24-05-2022 that showed single alive pregnancy
of gestational age 8 wks. She has done 5 ultrasounds during gestation. She
took folic acid in first trimester and all multivitamins later on in pregnancy
and visited multiple times in OPD for antenatal checkup and her first visit
was on 30-06-2022. She felt fetal movements in 5th month. Anomaly scan has
done. She has history of inc. frequency of urination throughout her
pregnancy which associated with burning in micturition in 7th month of
pregnancy for which she took cranmax sachet, syp citralka and tab cebosh.
She has fever 1 week before delivery that was low grade, gradual in onset,
more at night and relieved by Panadol. Now she has lower abdominal pain
that which is mild in intensity, dull in character, periodic and radiated to
back.

4. OBSTETRIC HISTORY
She is married since 1 yr. primigravida at GA 33+6 wks. Her LMP was
01-04-2022 and EDD was 08-01-2023.

5. GYNECOLOGICAL HISTORY
Patient’s age of menarche was 11 yrs. Her cycles were regular and are
5/22. She has normal flow. She has no history of any discharge,
dysmenorrhea, dyspareunia, intermenstrual and postcoital bleeding.
No history of any contraception and cervical smear.

6. PAST MEDICAL AND SURGICAL HISTORY
No history of any chronic illness, hospital admission and blood
transfusion. No history of any surgical procedure.
PERSONAL HISTORY
She has decreased appetite throughout her pregnancy. Normal sleep,
bowel habits and increase frequency.
FAMILY HISTORY
There is no significant disease in family.
SOCIOECONOMIC HISTORY
She lives in her own house, husband does private job.

7. ON EXAMINATION
AT THE TIME OF ADMISSION
A young female, with normal height and build, well oriented to time and
place and obeys command with proper eye to eye contact. Has following
vitals.
• VITALS
B.P=110/70 SUB-VITALS
PULSE=80bpm A+, Cl-, K-, J-, JVP-, LN-
RR=19/min
TEMP=A/F

8. EXAMINATON AND INVESTIGATION
• CBC
Hb=10.8
TLC=10000
Plt=173000
• MBG=B+ve
• V/M= non-reactive
• Urine D/R= normal
ORDERS
Admit patient in ward as she lives away
Make CR file and send fresh CBC
Counsel for good hydration
• PER ABDOMINAL
Abdomen soft, non-tender
SFH=38cm
FHS=audible(155 bpm)
FM= felt by mother
LIE= longitudinal
PRESENTAION= cephalic
U/C=mild 2/10
• PER VAGINAL
OS=1cm
CERVIX= firm and post
STAION= high
SHOW=-ve
No discharge, bleeding or
leaking
Membranes intact

9. EXAMINATION AND INVESTIGATION
AT TIME OF HANDING OVER
• CBC
Hb=11
TLC=14000
Plt=57000
• VITALS
B.P=100/70
PULSE=100bpm
RR= 17/min
TEMP= A/F
• PER ABDOMINAL
Abdomen soft, non-tender
SFH=38cm
FHS=audible(155 bpm)
FM= felt by mother
LIE= longitudinal
PRESENTAION= cephalic
U/C=mild 3/10
• PER VAGINAL
OS=3-4cm
CERVIX= firm and post
STAION= high
SHOW=-ve
No discharge, bleeding
or leaking
Membranes intact
• ORDERS
1. Arrange 6 manual platelets
2. High risk consent

10. • AT 1:30pm
4 manual platelets were transfused to patient
Patient was monitoring by drs and mode of delivery planned at that time was
SVD.
• AT 3pm
OS 5cm dilated, cervix soft, show +ve, membranes intact. Abdomen was soft
and non-tender and fetal heart sounds were audible.
• AT 7pm
OS was 5cm dilated, cervix soft, show +ve, PV fresh bleeding and membranes
were intact. Abdomen was hard and tender and fetal heart sounds were not
audible.
• ORDERS
Prepare patient for EM-LSCS.
Arrange 4 manual platelets.

11. OPERATIVE NOTES
• DATE AND TIME: 01-01-2023, 07:23pm
• PROCEDURE: EM-LSCS
• INDICATION:38 WKS Primigravida with suspected abruption.
• ANESTHESIA: SPINAL
• SURGEON: DR BANO QUDSIA
• O/C: IUD (Baby Girl)
• INTRAPERATIVE FINDINGS:
1. Lower segment well formed
2. FSB baby delivered as cephalic
3. Liquor adequate
4. Placenta posterior, few retro placental clots.
5. Normal tubes and ovaries.
6. EBL= 400ml
7. Urine output= 200ml

12. POST DELIVERY
• Emotional support and counselling as they are at increased risk of
PPD .
• Keep in non-maternity ward.
• Suppression of lactation(tight breast support, dopamine agonist,
estrogen)
• Counsel for future pregnancy.
• Contraceptive counseling.