Rh negative ...case presentation.

1. Rh NEGATIVE PREGNANCY

2. • Name-Rajni Devi
• Age-21 years
• Religion-Hindu
• Occupation-Housewife
• Married Life-2 years
• Husband’s name-Anil Kumar Ganesh
• Husband’s Occupation-Farmer
• Socio-economic status-Low
• Address-Maltoli ,Dighal bank,Kishanganj
• G2A1(A1 was 11 months back at 10 weeks of POG followed by D&E)
• LMP-13/5/2022
• EDD-20/2/2023
• POA-39 +1 weeks
• Blood group-B Negative
• Husband’s Blood group-O Positive
• DOA-14/2/2023
• DOE-14/2/2023

3. • Chief Complaints-
History of cesation of menses since 9 months
Pain lower abdomen since today morning 8 am
Leaking PV since today morning 5 am
Menstrual History-
LMP-13/5/2022
EDD-20/2/2023
POA on DOE-39+1 weeks
Menarche-14 years
Duration-4 days
Interval-28 days,regular cycles,normal flow,no clot
passage,no dysmenorhea or any other associated
symptoms

4. • Present Obstetric History- G2A1 at 39+1 weeks period of amenorrhea Confirmed pregnancy by UPT at 15
daysoverdue.Had regular ANC.She is booked case.
• 1st trimester-Uneventful
Took folic acid supplementation
Routine investigations done
.Blood group B Negative.
.Husband’s blood group-O Positive
ICT done at 1st visit at 11 weeks of POG and was negative
Sonography with NT scan was done at 13 weeks POG which was
normal with POG corresponding to POA.
.2nd trimester-Quickening felt at 16 weeks of POG and after that kept perceiving fetal movements regularly.
Iron and Calcium supplementation taken.
Td 2 doses taken at 16 weeks and 20 weeks of POG respectively
Anamoly scan done at 22 weeks POG.No obvious anamoly found.
ICT done at 28 weeks and was negative
Received prophylactic anti D at 28 weeks
3rd trimester- Uneventful
No history of trauma or bleeding per vagina in entire pregnancy duration
.

5. • Past Obstetric History-Abortion 11 months back at 10 weeks of
gestation followed by D&E.
Took ant D after abortion.
Past Medical/Surgical History- No significant medical or major surgical
history.
Family History- Nothing significant
Mother is also B Negative and 1st sibling is O Positive
She was 1st child and has 2 siblings of which only 1 is
alive.
2nd sibling died of neonatal jaundice
Mother didnt take anti D prophylaxis in any pregnancy
Personal History-Normal sleep,appetite,bladder,bowel
No history of any addiction,drug use or drug allergy
No history of any contraceptive use
No history of any blood transfusion

6. GENERAL SURVEY
Height-152 cm
Weight-62 kg
BMI-26.8
Alert,Conscious,Cooperative,normal facies,thin built,average nutrition,moderate pallor and
edema present but no icterus,clubbing and cynosis.
P-76bpm,BP-110/60mmhg by auscultatory method in sitting position,Temp-98.3 degree F
,Respi rate-18/min
Tongue,teeth,gum,tonsil-normal
Neck veins not engorged.Neck glands not palpable.Thyroid gland normal.
CVS- S1S2 Audible,No added sounds heard
Respiratory system - Bilateral Vesicular sounds heard,No adventitious sound
No Organomegaly

7. OBSTETRIC EXAMINATION
Breast Examination-No cracks,fissures,lump,discharge
Nipples depressed
Inspection-Large globular swelling in abdomen,flanks full,longitudnally placed,
Fundus convex with no notching,umbilicus everted,
Stria gravidarum and Linea Nigra seen,No scar mark on abdomen
Palpation-Fundal height corresponds to 40 weeks,SFH-38 cm
Fundal grip-broad ,soft,irregular,non ballotable mass felt suggestive of breech
Left lateral grip-hard,smooth curved resistant sttucture denoting back
Right lateral grip numerous small irregular mobile knobby structure felt suggestive of limbs
1st pelvic grip-small ,hard globular ballotable mass felt suggestive of head.Head is 4/5 palpable
2nd pelvic grip- Findings coraborated with 1 st pelvic grip.Examining fingers can be insinuated below presenting part
and hands remain convergent showing head is not engaged
Liquor seemed to be adequate and fetus seemed to be of average size and adequate weight.Abdominal girth is 100 cm.
Auscultation- FHR is 138-142 bpm heard midway along the left spinoumbilical line

8. • Per Speculum Examination- Active leaking present
• Per Vaginal Examination- Cervix posterior,os 2-3 cm dilated,early effaced,
cephalic presentation,membrane present,
show present,station high up
Investigations done-Blood grouping of patient and husband,hb%,serology after
informed consent and counselling,urine c/s,ICT ,PP blood
sugar after 75 gm of oral glucose,USG for fetoplacental profile
and amniotic fluid index.

9. SUMMARY
Mrs.Rajni Kumari 21 year old Gravida 2 Abortion 1 with B Negative blood group
(Husband blood group O Positive) was admitted on 14/2/2023
with complaint of pain abdomen and leaking since today morning amd is Rh Negative.
Her LMP was 13/5/2022 ,EDD was 20/2/2023 with period of amenorrhea of 39+1 weeks.
Her previous pregnancy was 11 months back which was aborted at 10 weeks of gestation by D&E.
She received anti D injection after D&E.Her menstrual history before conception was normal
and regular of 28 days interval.She has no significant medical or major surgical history.In present
pregnancy she had no history of trauma,bleeding PV or any blood transfusion.She had regular ANC
and no complication during pregnancy.Fetal movements was normal.
ICT was negative.She received prophylactic anti D at 28 weeks of POG.

10. On general survey height 152 cm,weight 62 kg,moderate pallor and mild pedal edema present but
no icterus,cynosis,and clubbing seen.
P-76bpm,BP-110/60 mmhg by auscultatory method in sitting position,Temp-98.3 degree F ,Respi
rate-18/min
On Obstetrical examination on per abdomen-fundal height is term size,SFH-38cm,Single
fetus,longitudnal lie,cephalic presentation,flexed attitude,head not engaged.
FHS is 142-146 bpm on left spinoumbilical line and average size baby with adequate liquor.On per
speculum examination active leaking was present.
On per vaginal examination cervix was posterior 2-3 cm dilated 20-30% effaced cephalic
presentation,membrane present,show present and head station high up.
Investigations reports showed hb-8.2 gm %,blood group B Negative,husband’s blood group O
Positive,serology non reactive,ICT Negative,urine CS showed no growth.

11. PROVISIONAL DIAGNOSIS
G2A1 Rh Negative pregnancy at 39+1 weeks period of gestation in early labor.

12. THANK YOU