The document presents a case study of a 25-year-old pregnant woman, Mrs. Sudha, who is Rh-negative and currently 37 weeks and 6 days into her pregnancy. She has undergone all necessary immunizations and investigations, with no significant medical complications, and is carrying a single live fetus in a longitudinal cephalic position. The treatment plan includes administration of anti-D immunoglobulin and routine evaluations leading up to delivery at 40 weeks.

1. Case Presentation
Rh negative pregnancy
Bhavana. R
Roll no. 23

2. A 25 year old primi Mrs.sudha w/o mr.madhuvaran from
villupuram educated upto BCA , homemaker belonging to
socioeconomic class according to modified B.G.prasad scale .
Ⅲ
LMP -17/03/2023
EDD -22/12/2023
With gestational age of 37 weeks 6 days came for safe confinement
Blood group of mother - O-ve
Blood group of husband - O+ve

3. HOPI
Able to perceive fetal movements
no h/o bleeding per vagina
no h/O leaking per vagina
No h/o abdominal pain
No h/o burning micturition

4. History of present pregnancy
1st trimester
Booked and immunised case
Spontaneous conception confirmed pregnancy after 45 days of amenorrhea by
UPT
Dating scan done and found to be normal
NT scan done and found to be normal
Folic acid tablets were taken
No h/o fever with rash
No h/o excessive vomiting
No h/o radiation exposure and drug intake
No h/o bleeding PV, burning micturition

5. 2nd trimester
Quickening felt at 5th month
h/o folic acid,iron and calcium tablets taken
Anomaly scan done and found to be normal
Two doses of TT taken (4 and 5th month)
OGCT done and found to be normal
No h/o bleeding or leaking pv
No h/o headache,blurring of vision,epigastric pain,decreased urine output

6. 3rd trimester
Continue to perceive fetal movements
h/o iron and calcium tablets intake
Growth scan done and found to be normal
No h/o abdominal pain,bleeding / leaking PV
No h/o imminent symptoms of preeclampsia
ICT done at 28 weeks of gestation and found to be negative
h/o costly injection taken at 28 weeks of gestation

7. Menstrual history
LMP-17/03/2023
she attained menarche at the age of 14 years
Regular 5/28 days cycle,changes 3-4 pads/day
Not associated with pain during menstruation or passage of clots

8. Marital history
Married since 1 year at 24 years of age
Non-consanguineous marriage

9. Past history
Not a known case of DM,HT,TB,asthma,epilepsy,CAD, bleeding disorder
No h/o previous surgeries,drug intake
No h/o blood transfusion

10. Personal history
Consumes mixed diet
Normal bowel and bladder habits
Normal sleep pattern
No addictive habits

11. Family history
No significant family history

12. General Examination
● Patient is conscious,oriented,afebrile,moderately built and moderately nourished
● No pallor,icterus,cyanosis,clubbing, generalized lymphadenopathy,pedal edema
● VITALS:
● Pulse -82bpm - regular rhythm,normal volume,no specific character,no radio-femoral delay
● Blood pressure -120/80 mm Hg
● Respiratory rate - 16 breaths /min
● Temperature - 37.4℃
● Height - 159 cm
● Pre-pregnancy weight - 58 kg
● Present weight - 71kg
● BMI -22.9
● Breast,thyroid,spine examination -normal

13. Abdominal examination
After getting consent and asking her to empty her bladder patient lie in supine
position with semiflexed leg, exposed from xiphisternum to pubic symphysis
INSPECTION
Abdomen distended longitudinally
Umbilicus in midline and everted,flanks full
Linea nigra, Striae gravidarum seen
No scar, no sinus, no dilated veins

14. palpation
Fundal height corresponds to 36 weeks of gestation,flanks full
Symphsiofundal height - 36 cm
Abdominal girth -98cm
FUNDAL GRIP - soft,broad mass,not independently ballotable
UMBILICAL GRIP - right side -smooth curved,uniform resistance
felt,probably spine
Left side - multiple small nodules felt probably limb buds
FIRST PELVIC GRIP - hard,round,independently ballotable fetal part felt
at lower pole of uterus probably head
SECOND PELVIC GRIP - not engaged

15. Auscultation
Fetal heart sound is felt at right spino umbilical line
Fetal heart rate - 140 bpm,regular rhythm
Other systemic examination
CVS -S1,S2 heard, no murmur
RS -normal vesicular breath sound heard,no added sounds
CNS - no focal neurological deficit

16. SUMMARY
A 25 Year old primi Mrs.Sudha with o-ve blood group whose LMP-17/03/23, EDD-
22/12/2023 with gestational age 37 weeks & 6 days,booked and immunised married to o+ve
husband,spontaneous conception ,anti-D injection taken with no other comorbidities.O/E
fundal height corresponds to 36 weeks , a single live fetus,longitudinal lie,cephalic
presentation,with good fetal heart sound came for institutional evaluation and treatment
DIAGNOSIS:
A 25 year old primi Mrs.sudha whose blood group is O-ve,gestational age-37 weeks & 6 days
with single live fetus,longitudinal lie,cephalic presentation,head not engaged with good fetal
heart sound, without medical and obstetric complications came for institutional evaluation
having Rh -ve pregnancy

17. INVESTIGATION
● Blood grouping and Rh typing of mother and father’s blood
● Complete blood count
● Indirect coombs test
● USG assessment
● Fetal surveillance
● Routine investigations

18. Treatment
● 300 µg anti-D immunoglobulin at 28 weeks.
● Deliver at 40 weeks
● Collect cord blood sample for investigation
● Postpartum anti-D immunoglobulin 300 µg