1. The document discusses a case study of a 18-year old pregnant patient who was admitted to the hospital complaining of severe lower abdominal pain and vaginal bleeding at 9 months of pregnancy. 2. Upon examination, her cervix was dilated 2 fingers and the placenta was descending. She gave birth via c-section to twin boys who were in good health. 3. Her treatment in the hospital included antibiotics, analgesics, oxytocin to stimulate uterine contractions, and supplements via IV. She was prescribed additional antibiotics and NSAIDs upon discharge.

1. Practice clinical
pharmacy
Gynecology &
Obstetrics department
(case 1)
BY : DR. Safia A. Alrezami

3. Defination
is delivary of the baby through operation via abdominalwall
Causes
Releated to fetus
Malpresentation & malpostion, Multiple pregnancy(twin)
Large baby Planenta previa placenta abrouption
Umblical cord problem
Related to mother
contractedpelvis ,maternal diseases(heart disease eclampsia or
preclampsia , Pelvic tumor

4. Incidence twin is one in 80 of pregnancies .
Types of twins
- uniovlar(identical) twin 30%
They result from division of a single fertilized ovum
-binovular (dizygotic) twin 70%: They result from
fertilization of two separate
ovum

5. Management
During labour
Delivery must be in hospital
If labour strat before 38week the
mother is given 2g ampicillin IV
every 6 hour until delivery to
prevent group B streptococcal
infection in the newborn.
the docter after examintation
give decision about the route of
delivery( narmol or need to
operation (L.C.S.C )
During pregnancy
-Diet the mother is given more
nutrient kilocalories, protein, iron
,Ca, folic acid and vitamins.
- frequency moniter by Dr. to
give the suitable adivce

7. Personl history
Patient Name: X file no ,255
Age: 18 years work as housewife
Admission date 3-3-2013
discharge date 8-3-2013
The main compliance
The patient 9 month of pregnancy complaining of sever
lower abdominal pain associated with vaginal bleeding.

8. Medical & past history
The patient has no history of HTN or DM or taken any
drugs. Also there is no past history of hospitalization .
Both parents have no any chronic diseases
Primary diagnosis
-patient in labour. (delivery)
Differential diagnosis
_Time of delivery (normal or operation).
placenta previa _Abruption placenta.

9. The physical examination
She is look well &awake and can walk
BP 130 95 mmhg Pulse 64 beat per minute
Respiratory rate 20
Vaginal examination cervix open 2 fingers and the placenta is first
descent the
Investigation
Hb =11.88 R.B.S =65mgdl Blood group ( O+ )
Protective tests)HIV , HCV , HBsAg ….. Negative (
Serum cretinine 0,7 mg dl.

10. the operation was done and she birth twin(two bobies),
two boys they are in good health then transfer to
department to necessary care
NOWwhat about the Treatment
?


11. therapeutic Taken or not
use
The trade drug 1The drug Dose
Yes
2day
Dextrose 5% 1 3 Supplement
infusion
Dextrose
Yes
2day
Supplement
1 2
Normal saline
500cc infusion
Normal
Saline
In patient drugs

12. therapeutic Taken or not
use
The trade drug The drug Dose
Yes
3day
Antibiotic
Anaerobic)
Metronidazol 1 3
500mg infusion
Flagyl
Yes
3day
Antibiotic
(cephalospor
in)
1 2
Ceftriaxone
1g vial
Cefex
In patient drugs

13. therapeutic Taken or not
use
The trade drug The drug Dose
Tramadol 1 3 Analgesic SOS
100mgml amp
Tramal
first day
Post op.
PREVENT
FIBRINOLYSIS
1
2
Tramexic
Acid250mg2ml
Tramexi c acid
Yes
2Day
Stimulate
Utrine
contraction
Oxytocin 10 I.U. 1 1
Ampule
Oxytocin
In patient drugs

14. Out patient drugs
therapeutic Preoid
use
The trade drug The drug Dose
1 Antibiotic 5 days MOXACILLINE 3
LAVERUONIC
ACID )1g tab
Metronidazole 1 3 Antibiotic One week
500mg tab
)Diclofene Sodium ----- NSAIDs SOS
75mg3ml ampule
IM