Khukhumoni Bibi, a 29-year-old pregnant woman, presented with weakness, dizziness and oral lesions. She had her first prenatal visit at 12 weeks, and testing at 16 weeks found hemoglobin of 6.7 g/dL, but she did not take therapeutic iron. By 32 weeks, her hemoglobin had dropped to 5.9 g/dL. Examination found pallor but no other abnormalities. Testing confirmed severe iron deficiency anemia at 32 weeks of gestation.

1. CASE PRESENTATION BY
UNIT 1B
SEVERE ANAEMIA AT 34 WEEKS OF GESTATION

2. HISTORY OF THE CASE

3. PATIENT PROFILE
 Name – Khukumoni Bibi
 Age – 29 years
 Religion – muslim
 occupation - housewife
 Occupation of husband- Tailor
 Address- Badra tala ,Nadial , South 24 Parganas
 Duration of marriage- 8years

4.  Parity – G2 P1+0+0+1
 Last menstraul period – 26/12/2021
 Expected date of delivery – 03/10/2022
 Period of gestation –35 + 1
 Date of admission – 19/08/2022
 Date of examination – 29/08/2022

5. CHIEF COMPLAIN
 Referred from Garden Reach State General
Hospital due to low haemoglobin level

6. HISTORY OF PRESENTING ILLNESS
 Patient was not a booked case of any health facility
 Patient had her 1st antenatal visit at 12 weeks of
gestation at a private clinic
 She was started iron folic acid calcium
supplementation
 She had her 1st antenatal investigations at 16
weeks of gestation which reveled low haemoglobin
6.4g/dl
 Patient revealed she recived iron tablets once daily

7.  Further patient complained of oral lesion , and loss
of apetite
 Later she also developed giddiness, general
weakness , lethargy.
 No history of shortness of breath, palpitation
 No history of syncopal attack
 No bleeding pv
 No per rectal bleeding
 No perianal itching

8.  Despite iron supplementation hb did not improve .
So she was referred to any state medical hospital
with Hb-5.9g/dL
 Patient was admitted via emergency Room at
SSKMH
 On admission, her USG for Fetoplacental profile
and CTG was done and found to be normal
 Routines including blood for Complete Blood
Count,Red blood cell indices,serum ferritin,Hb
electrophoresis &serology were sent
 High risk counselling done

9. HISTORY OF PRESENT PREGNANCY
 Pregnancy was Unplanned
 Confirmed by urine pregnancy test
 Pt was immunised ;received 2 doses of tetanus
toxoid
 All routine routine antenatal investigations done
 Hb level on 1st check up at 12 weeks was 6.7g/dl
 She received only prophylactic iron dose
 Quickening at 5months of gestation
 Fetal movement was well appreciated
 Only one usg was done at 33 weeks

10. OBSTETRIC HISTORY
 P1-
 Term Baby, live and healthy girl child 3.2kg birth
weight
 Pregnancy, labour and puerperium was uneventful
 Spontaneous vaginal delivery

11. MENSTRUAL HISTORY
 Attained Menarche at 12 yrs of age
 Regular cycles with normal flow for 5-7 dya in a 28-
32 days cycle
 No history of dysmennorhoea
 No history of menorrhagia
 Last Menstrual Period- 26/12/2021
 Expected Date of Delivery(Naegele’s formula)
3/10/22

12. PAST MEDICAL HISTORY
 No history of tuberculosis,
heart disease,urinary tract infection
hypothyroidism or any other illness.
 There is past history of hookworm infestations for
which she took medications
 No history of lood transfusion

13. PAST SURGICAL HISTORY
 nil

14. FAMILY HISTORY
 She is youngest of 4 siblings
 Family history shows no history repeated blood
transfusion
 No history of tuberculosis, blood dyscrasias , nown
hereditary disease
 No history of consanguinous marriage

15. PERSONAL HISTORY
 history of loss of appetite
 Normal sleeping pattern
 Normal bowel and bladder habits
 Non smoker
 Non –alcoholic
 No known drug allergy
 No history of previous blood transfusion

16. SOCIO-ECONOMIC HISTORY
 Monthly income 5000
 Literacy of earnig member IV standard

17. EXAMINATION OF THE CASE

18. GENERAL PHYSICAL EXAMINATION
 Patient is alert, conscious,co-operative and comfortably
lying on the bed
 She is of normal built and moderately nourished
 Her BMI-
 Vitals: BP- 120/74 mm Hg,Pulse-88bpm,regular,normal
volume,all peripheral pulses are equally palpable
 Respiratory rate-18 breath per minute
 Temperature- 37degree centigrate

19.  No jaundice
 Pallor present over lower palpebral conjunctiva ,
nailbeds,dorsum of tongue
 Glossitis + , Stomatitis +, Cheilitis- noted
 No obvious neck swelling,
 No cervical lymphadenopathy
 No engorged neck veins
 Breast- No lumps ,no nipple discharge
 Lower limbs- No pedal edema

20. ABDOMINAL EXAMINATION
 INSPECTION
 Abdomen uniformly distended and longutinally
ovoid.
 Linea nigra,stria gravidum are present
 Umbilicus centrally placed and inverted
 No scar mark or evidence of skin infection seen
 PALPATION
 Clinical fundal height~34 weeks
 Symphysiofundal height corresponding to
34 weeks

21.  FUNDAL GRIP:
 Soft,Broad,Non-Ballotable fetal buttock
 LATERAL GRIPS: Curved broad surface –fetal back on
maternal right side
 Irregular knob like structure felt on maternal left side =
fetal limbs
 PAWLICK GRIP :Hard globular ballotable mass
 PELVIC GRIP: Head not engaged
 AUSCULTATION
 Foetal heart sound heard on maternal right spino
umbilical line

22. VAGINAL EXAMINATION
 Patient was not in labour
 There was no vulval edema
 No vaginal discharge
 Other systemic examination
 -nothing significant

23. INVESTIGATIONS
 Complete blood count
1. Hb – 6.3g/dl
2. MCV- 74 fl
3. MCH -23.1 pg
4. MCHC - 30
5. RBC count – 3.8million /cu mm
6. Haematocrit – 29.3%
7. RDW – 25.8
8. WBC – 9800/mmcu
9. Platelet – 2 lakhs/cu mm

24.  Peripheral blood film
1. Microcytic hypochromic RBCs
2. Anisocytosis
o Iron profile
1. Serum iron 30 µg/dl
2. serum ferritin 20 µg/L
3. TIBC 420 µg/dl
 HPLC – report awaited

25.  Trans abdominal Ultrasonography
- Corresponding to POG

26. CASE SUMMARY
 Mrs. Khukhumoni, 29 year old second gravida
presented to the Emergency Room with complain of
generalised weakness, giddiness,lassitude and oral
lesions.
 She was an unbooked case and and she had her
1st antenatal check up at 12 weeks of gestation
 She did her 1st antenatal investigations at 16 weeks
of gestation which revealed hb to be 6.7 g/dl
 However , she did not consume therapueutic dose
of iron then


27.  She developed oral lesions viz. stomatitis, glossitis
 It led to loss of aprtite
 Further she developed general weakness ,
lassitude, giddiness
 At 32 weeks of gestation , she visited a private
practitioner . Hb reveled to be 5.9g/dl
 She was referred to higher state genera/ medical
college and hospital
 She presented at SSKMH

28.  On examination pallor was present with no signs of
cardiac failure .her SFH was 32cm ,single fetus
cephalic presentation FHS 132beats per minute
regular
 Routines along with peripheral blood film and iron
profile was done.

29. PROVISIONAL DIAGNOSIS
Severe anemia at 32 weeks of gestation probably due
to iron deficiency anemia