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Morning session
Red Unit
17/10/2015
Dr. Namkha Dorji
Resident (Phase-B)
Obstetrics and Gynaecology
BSMMU
10/17/15 1
Dr Nam...
Total admission
Date No. of admission (Red Unit)
10/10/15 4
11/10/15 5
12/10/15 4
13/10/15 2
14/10/15 4
25/10/15 3
Total p...
Case 1
• Name: Mrs. Afroza Sultana
• Age: 31 year
• Married for: 6 years
• Para: (0)
• Gravida: 1
Primigravida at 36+6
wee...
Case 2
• Name: Mrs. Arzina Khatun
• Age: 27 year
• Married for: 5 years
• Para: (0 + 2)
• Gravida: 3rd
3rd
gravida at 30+6...
Case 3
• Name: Mrs. Shahnaj Begum
• Age: 33 years
• Para: (3+0)
• Gravida: 4th
• Diagnosis:
4th
gravida at 37+1
weeks of t...
Discordant Twin
LUCS with BLTL
T 1 in breech, male, 3 kg
T2 in Transverse lie, male,
1.8 kg
Two placentas and two
membrane...
Case 4
• Name: Mrs. Shamima Begum
• Age: 36 year
• Para: (2+0)
• Gravida: 3rd
• Diagnosis:
3rd
gravida at 35+5
weeks pregn...
Case 5
• Name: Mrs. Swapna Begum
• Age: 21 year
• Para: (0)
• Gravida: 1st
• Diagnosis:
Echo:
Mitral valve-0.8cm3
,PASP 98...
Case 6
• Name: Mrs. Lima
• Age: 25 year
• Married for: 1 year
• Para: [0]
• Gravida: 1st
• Diagnosis:
Primi at 29+ weeks p...
Medical Termination of Pregnancy
• MTP with PGE2 gel
• Male
• 1.5 kg
• Huge ascitis
• Hydrocele
• Short long bones
10/17/1...
Case 7
• Name: Mrs. Sumoti Rani
• Age: 35 year
• Para: (2+0)
• Gravida: 3rd
• Diagnosis:
3rd
gravida at 37+6
weeks pregnan...
Case 8
• Name: Mrs. Khadiza
• Age: 25 year
• Married for: 9 years
• Para: (1+6)
• Gravida: 7th
• Diagnosis:
•
7th
Gravida ...
Case 9
• Name: Mrs. Taslima
• Age: 20 year
• Para: [1+1]
• Gravida: 3rd
• Diagnosis:
3rd
gravida at 32+ weeks pregnancy wi...
Case 10
• Name: Mrs. Afrin
• Age: 24 year
• Para: (1+0)
• Gravida: 2nd
• Diagnosis:
2nd
gravida at 36+6
weeks pregnancy wi...
Case 11
• Name: Dr Shireen
• Age: 32 year
• Para: (1+1)
• Gravida: 3rd
• Diagnosis:
3rd
gravida at 37+5 weeks pregnancy in...
Case 12
• Name: Mrs. Sajeeda
• Age: 35 year
• Para: (1+0)
• Gravida: 2nd
• Diagnosis:
2nd
gravida at 37+3
weeks pregnancy ...
Case 13
• Name: Mrs. Sumi
• Age: 26 year
• Para: (1+0)
• Gravida: 2nd
• Diagnosis:
2nd
gravida at 37+4
weeks pregnancy in ...
Case 14
• Name: Mrs. Rokeya
• Age: 32 year
• Para: (2(NVD)+0)
• Gravida: 3rd
• Diagnosis:
3rd
gravida at 38+
weeks pregnan...
Case 15
• Name: Mrs. Suborna
• Age: 23 year
• Married for: 3 years
• Para: Primi
• Gravida: 1st
• Diagnosis:
Primi at 38+6...
Non reactive CTG
• HR- 140bpm
• Variability
Reduced
• Acceleration
Absent
• Deceleration
Absent
10/17/15
Dr Namkha Dorji, ...
Case 16
• Name: Mrs. Farida Yasmin
• Age: 31 year
• Para: (0+I)
• Gravida: 2nd
• Diagnosis:
2nd
gravida at 38+
weeks pregn...
Case 17
• Name: Mrs. Israt Karim
• Age: 29 year
• Married for: One year
• Para: (0)
• Gravida: primi
• Diagnosis:
Primigra...
Case 18
• Name: Mrs. Rehana
• Age: 28 year
• Married for: 4 years
• Para: (0)
• Gravida: 1st
• Diagnosis:
Primigravida at ...
Case 19
• Name: Mrs. Jesmin Akter
• Age: 34 year
• Married for: 2 years
• Para: (0)
• Gravida: 1st
• Diagnosis:
Primigravi...
Case 20
• Name: Mrs. Parveen
• Age: 42 year
• Para: 3(NVD)+3(1MR+2 MC)
• Gravida: 7th
• Diagnosis:
7th
gravida at 34+1
wee...
Case 21
• Name: Mrs. Narun Nahar
• Age: 26 year
• Para: (2+0)
• Gravida: 7th
• Diagnosis:
3rd
gravida at 24+6
weeks triple...
Case 22
• Name: Mrs. Rima Khatun
• Age: 18 year
• Para: (0+1 MR)
• Gravida: 2nd
• Diagnosis:
2nd
gravida at 37+
pregnancy ...
10/17/15 28
Dr Namkha Dorji, Resident, OBGYN,
BSMMU
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High risk pregnancy cases

High risk pregnancies are admitted in the Fetomaternal Unit, Department of Obstetrics and gynaecology, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh. As a part of academic activities, all the cases admitted in the previous week are presented in the morning session by one of the Doctor working in the Unit.

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High risk pregnancy cases

  1. 1. Morning session Red Unit 17/10/2015 Dr. Namkha Dorji Resident (Phase-B) Obstetrics and Gynaecology BSMMU 10/17/15 1 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  2. 2. Total admission Date No. of admission (Red Unit) 10/10/15 4 11/10/15 5 12/10/15 4 13/10/15 2 14/10/15 4 25/10/15 3 Total patients admitted = 22 10/17/15 2 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  3. 3. Case 1 • Name: Mrs. Afroza Sultana • Age: 31 year • Married for: 6 years • Para: (0) • Gravida: 1 Primigravida at 36+6 weeks pregnancy with fetal distress with oligohydramnios with IUGR and h/o primary subfertility. . Diagnosis: LUCS findings: •Female •2.1 kg •Reduced volume but clear liquor • Cord round the neck USG: •AFI = 4.6 cm •EFW = 2040 grams 10/17/15 3 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  4. 4. Case 2 • Name: Mrs. Arzina Khatun • Age: 27 year • Married for: 5 years • Para: (0 + 2) • Gravida: 3rd 3rd gravida at 30+6 week pregnancy with preterm labour with fetal distress . Diagnosis: 1st = MR at 2 months 2nd = Complete abortion at 2 months 10/17/15 4 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  5. 5. Case 3 • Name: Mrs. Shahnaj Begum • Age: 33 years • Para: (3+0) • Gravida: 4th • Diagnosis: 4th gravida at 37+1 weeks of twin pregnancy (DADC) with severe preeclampsia with p/h/o one LUCS with hypothyroidism and obesity (grade I) BMI: 33 kg/m2 •1st & 2nd pregnancies: NVD •3rd pregnancy: LUCS due to Postdated pregnancy Tab. Thyrox 100 mcg/day Tab. Sardopa 250 mg TDS Tab. labeta 200mg BD BP: 170/110mmg Urine bedside: 3+ 10/17/15 5 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  6. 6. Discordant Twin LUCS with BLTL T 1 in breech, male, 3 kg T2 in Transverse lie, male, 1.8 kg Two placentas and two membranes 10/17/15 6 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  7. 7. Case 4 • Name: Mrs. Shamima Begum • Age: 36 year • Para: (2+0) • Gravida: 3rd • Diagnosis: 3rd gravida at 35+5 weeks pregnancy with APH due to central placenta praevia with p/h/o one LUCS. P1: NVD P2: LUCS(2011) ? Fetal Distress USG: Anterior placenta extending up to os and covering it 10/17/15 7 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  8. 8. Case 5 • Name: Mrs. Swapna Begum • Age: 21 year • Para: (0) • Gravida: 1st • Diagnosis: Echo: Mitral valve-0.8cm3 ,PASP 98 mmHg Drugs: Tab Pen VK 250 mg BD Tab Lasix 20 mg OD Tab Labeta 200 mg BD NVD: male, 1.4 kg Primi at 32+2 weeks pregnancy in preterm labour with chronic rheumatic heart disease (severe MS, Gr IV TR, severe pulmonary HTN and NYHA-Grade II) 10/17/15 8 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  9. 9. Case 6 • Name: Mrs. Lima • Age: 25 year • Married for: 1 year • Para: [0] • Gravida: 1st • Diagnosis: Primi at 29+ weeks pregnancy with multiple fetal congenital anomalies with severe oligohydroamonios USG •AFI: almost nil •Huge ascitis, short long bones, Hydronephrosis, Hydrocele 10/17/15 9 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  10. 10. Medical Termination of Pregnancy • MTP with PGE2 gel • Male • 1.5 kg • Huge ascitis • Hydrocele • Short long bones 10/17/15 10 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  11. 11. Case 7 • Name: Mrs. Sumoti Rani • Age: 35 year • Para: (2+0) • Gravida: 3rd • Diagnosis: 3rd gravida at 37+6 weeks pregnancy with dilated cardiomyopathy (NYHA-II) with chronic hypertension with p/h/o one LUCS Echo: Dilated CM, Dilated LV with Borderline dilated LA, RWMA+ , mod. global hypokinesia with preserved wall thickness mod LV systolic dysfunction(EF 38%) Mild MR, Trivial TR P1: NVD P2: LUCS due to PP ALC: 4 years USG: Placenta posterior and away from os EFW: 2821 gram AFI: 12 cm 10/17/15 11 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  12. 12. Case 8 • Name: Mrs. Khadiza • Age: 25 year • Married for: 9 years • Para: (1+6) • Gravida: 7th • Diagnosis: • 7th Gravida at 36+1 week pregnancy with PIH with Rh Isoimmunisation with bad obstetrics history with no living issue. Anti D anti body 23/9/15 (1: 16) 13/10/15 ( 1:64) P1-3, 5 and 6: abortion between 3 to 6 months P4: home delivery and expired at 7 days of age ? Cause of deah- no jaundice. Wife: A–ve Husband: A+ve Genotyping: Homozygous ANTI D – not received. USG AFI: 14 cm EFW: 2285 gram No hydropic changes 10/17/15 12 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  13. 13. Case 9 • Name: Mrs. Taslima • Age: 20 year • Para: [1+1] • Gravida: 3rd • Diagnosis: 3rd gravida at 32+ weeks pregnancy with preeclampsia with IUGR and oligohydramnios with p/h/o one IUD USG EFW- 1028 g AFI- 4.7 cm P1: abortion at 2 months P2: IUD at 8 months 10/17/15 13 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  14. 14. Case 10 • Name: Mrs. Afrin • Age: 24 year • Para: (1+0) • Gravida: 2nd • Diagnosis: 2nd gravida at 36+6 weeks pregnancy with PROM with GDM(on insulin) with Preeclampsia with p/h/o one LUCS P1: LUCS ALC 6 year BP and Blood sugar under control: • Inj. Actrapid 8+8+6 • Tab Sardopa 250 mg TDS • Tab Labeta 100mg BD 10/17/15 14 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  15. 15. Case 11 • Name: Dr Shireen • Age: 32 year • Para: (1+1) • Gravida: 3rd • Diagnosis: 3rd gravida at 37+5 weeks pregnancy in active labour with fetal distress with p/h/o one LUCS P1: MTP at 25 weeks due to intracranial posterior fossa tumour P2: LUCS ALC: 3 years 10/17/15 15 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  16. 16. Case 12 • Name: Mrs. Sajeeda • Age: 35 year • Para: (1+0) • Gravida: 2nd • Diagnosis: 2nd gravida at 37+3 weeks pregnancy with fetal distress with preeclampsia with p/h/o one LUCS P1: LUCS due to severe preeclampsia ALC: 6 years USG Cephalic presentation EFW: 3100 grams Placenta: fundal AFI: 9.15 cm BP controlled by Tab. Sardopa 250 mg TDS 10/17/15 16 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  17. 17. Case 13 • Name: Mrs. Sumi • Age: 26 year • Para: (1+0) • Gravida: 2nd • Diagnosis: 2nd gravida at 37+4 weeks pregnancy in active labour with scar tenderness with p/h/o one LUCS with Hypothyroidism and GDM on Insulin. 10/17/15 17 Dr Namkha Dorji, Resident, OBGYN, BSMMU P1: LUCS due to prolonged labour ALC: 6 year LUCS findings: Partial uterine rupture Live fetus
  18. 18. Case 14 • Name: Mrs. Rokeya • Age: 32 year • Para: (2(NVD)+0) • Gravida: 3rd • Diagnosis: 3rd gravida at 38+ weeks pregnancy with space occupying lesion in right lobe of liver. 10/17/15 18 Dr Namkha Dorji, Resident, OBGYN, BSMMU USG: •Enlarged liver •Lobulated mixed echogenic mass in right lobe (14*13cm) • serum alpha FP : 86.69 ng/ml • other LFT & viral markers - normal Clinically: •No icterus •Hepatomegally present.
  19. 19. Case 15 • Name: Mrs. Suborna • Age: 23 year • Married for: 3 years • Para: Primi • Gravida: 1st • Diagnosis: Primi at 38+6 weeks pregnancy with fetal distress ? Fetal distress! Reduced fetal movement Non reactive CTG 10/17/15 19 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  20. 20. Non reactive CTG • HR- 140bpm • Variability Reduced • Acceleration Absent • Deceleration Absent 10/17/15 Dr Namkha Dorji, Resident, OBGYN, BSMMU 20
  21. 21. Case 16 • Name: Mrs. Farida Yasmin • Age: 31 year • Para: (0+I) • Gravida: 2nd • Diagnosis: 2nd gravida at 38+ weeks pregnancy with GDM on insulin. P1: complete abortion at 2 months (2013) 10/17/15 21 Dr Namkha Dorji, Resident, OBGYN, BSMMU
  22. 22. Case 17 • Name: Mrs. Israt Karim • Age: 29 year • Married for: One year • Para: (0) • Gravida: primi • Diagnosis: Primigravida at 38+3 weeks pregnancy with fibroid uterus. 10/17/15 22 Dr Namkha Dorji, Resident, OBGYN, BSMMU LUCS with Myomectomy done: Female baby 3.1 kg Intramural fibroid (8*7 cm) in the lower segment of anterior wall.
  23. 23. Case 18 • Name: Mrs. Rehana • Age: 28 year • Married for: 4 years • Para: (0) • Gravida: 1st • Diagnosis: Primigravida at 36+3 weeks pregnancy with IUGR with hypothyroidism with h/o primary subfertility. 10/17/15 23 Dr Namkha Dorji, Resident, OBGYN, BSMMU Biochemically euthyroid on Tab Thyrox 150 microgram daily. USG on 03/10/2015 Cephalic presentation AFI: 7.2 com EFW: 1547 cm
  24. 24. Case 19 • Name: Mrs. Jesmin Akter • Age: 34 year • Married for: 2 years • Para: (0) • Gravida: 1st • Diagnosis: Primigravida at 33+3 weeks pregnancy with APH with hypothyroidism and bronchal asthma. 10/17/15 24 Dr Namkha Dorji, Resident, OBGYN, BSMMU Biochemically euthyroid on Tab Thyrox 50 microgram daily. USG on 09/09/2015 Cephalic presentation AFI: 14 com Placenta: posterior and away from os
  25. 25. Case 20 • Name: Mrs. Parveen • Age: 42 year • Para: 3(NVD)+3(1MR+2 MC) • Gravida: 7th • Diagnosis: 7th gravida at 34+1 weeks of pregnancy with eclampsia. 10/17/15 25 Dr Namkha Dorji, Resident, OBGYN, BSMMU On admission: BP= 180/110 mmHg Urine albumin= 4 + Management: Inj. MgSO4 administered Emergency LUCS and BLTL done Female baby weighing 2100 gram Patient Stable
  26. 26. Case 21 • Name: Mrs. Narun Nahar • Age: 26 year • Para: (2+0) • Gravida: 7th • Diagnosis: 3rd gravida at 24+6 weeks triplet pregnancy (MAMC) with polyhydramnios with maternal distress 10/17/15 26 Dr Namkha Dorji, Resident, OBGYN, BSMMU 2 NVD- one alive (6 year) Other died at 1 and ½ year due to ? Autistic Disorder Natural conception USG (MAMC) on 10/10/15 T1: 326 g, T2: 332 g, T3: 300 g. AFI: ?
  27. 27. Case 22 • Name: Mrs. Rima Khatun • Age: 18 year • Para: (0+1 MR) • Gravida: 2nd • Diagnosis: 2nd gravida at 37+ pregnancy with multiple fetal congenital anomalies( hydrocephalus and right renal cyst) 10/17/15 27 Dr Namkha Dorji, Resident, OBGYN, BSMMU Unplanned pregnancy No preconceptional counselling USG Cephalic presentation lateral ventricles dilated (right= 49.7 mm & right=38mm) BPD= 100 mm. AFI= 16 mm Cystic area in right kidney(70*60 mm)
  28. 28. 10/17/15 28 Dr Namkha Dorji, Resident, OBGYN, BSMMU

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