It's about case study of obscenity and gynecologist

1. CASE PRESENTATION
OBSTETRICS AND GYNAECOLOGY
NAME: HARINI.V
COURSE: PHARM.D – V YEAR
REG NO: I17060008
DEPARTMENT: PHARMACY
DATE: 1/4/22

2. PATIENT DETAILS:
Name: xxx A/S: 41 years/F IP no: 893541 U/W: OG-IV/15
DOA: 23/9/21 DOS: 28/9/21 DOD: 4/10/21
CHIEF COMPLAINCE:
A 41 years old female came with a complaints of mass descending p/v since 3 years
C/O white discharge p/v since 3 years
HISTORY OF PRESENT ILLNESS:
H/O difficulty in sexual intercourse
H/O burning micturition for 4 months
H/O low back pain for 2 months
No h/o palpitation, breathlessness, fatigue
No h/o bleeding p/v
No h/o bowel disturbances
No h/o cough, fever, cold

3. MENSTRUAL HISTORY:
Attained menarche at 13 years of age
Regular cycle 5/30 cycle, moderate flow No of pads usage- 3/day
Not associated with pain and passage of clots
Attained menopause since 3 years
MARITAL HISTORY:
Married since 18 years, NCM
OBSTETRICS HISTORY : P1L1
An alive female, birth weight- 2.5 kg, NVD, postnatal period was uneventful now 16 years
PAST HISTORY:
N/K/C/O DM, HT, epilepsy, thyroid disorder No h/o any previous surgery.
O/E:
GC fair, afebrile, no pallor, no pedal edema
BP- 120/80 mm Hg , PR- 98/min
CVS- S1S2 RS- BAE
P/A: Soft, non tender

4. LOCAL EXAMINATION:
Cervix lying outside the introitus, not able to get above the swelling, cervix hypertrophied, no ulceration, no keratinization, white
discharge present, no cystocele, no rectocele, no stress incontinence, levator anti posterior normal.
P/V:
Uterus normal size, mobile, fornices free.
LAB INVESTIGATIONS:
Urine routine: Alb-nil, Sugar- nil
Deposits: 1-4 pus cells/Hpf
0-2 epi cells/Hpf
HIV- non reactive,
VDRL- non reactive,
HBsAg- negative

5. PARAMETERS MARKED VALUE NORMAL RANGE UNITS
Hemoglobin 11.5 12-16 g/dl
RBS 78 80-130 mg/dl
Platelet 3.26 1.5-4.5 Lakhs/ml
Blood urea 21 14-23 mg/dl
S. creatinine 0.8 0.7-1.1 mg/dl
LFT: total bilirubinDirect
SGOT SGPT
ALP
0.7
0.2
20
28
185
0.2-1.3
0-0.3
10-59
10-40
44-147
mg/dlmg/dl
U/L U/L
IU/L
S.electrolytes: Na+
K+ CL-
137
4.4
104
136-146
3.5-4.5
96-106
mmol/l
mmol/l
mmol/l
TSH 6.239 0.5-5 mIu/l
Free T3 3.518 2.3-4.1 Picogram/ml
Free T4 1.232 0.7-1.9 Nanogram/dl

6. Chest x-ray – normal study
ECG- HR: 80/min, normal axis, normal rhythm, no ST, T changes
ECHO:
 Ejection fraction: 63%,
 Grade I diastolic dysfunction,
 Adequate LV function,
 No RWMA at rest,
 No significant PAH.
USG abdomen:
Non gravid retroverted Uterus
ET- 3mm, Visualized abdominal organs sonologically normal, no free fluid.
CT thorax:
Bilateral mild pleural effusion present, CORADS-1
Medicine opinion obtained for hypothyroidism and started on Tab. Eltroxin 50 mcg, cardiopulmonary status stable at present.

7. MACROSCOPIC EXAMINATION:
• Container has a specimen of uterus with cervix measuring 12x4x3 cm.
• On cut section of uterus with cervix – endometrial cavity identified.
MICROSCOPIC EXAMINATION:
• Cervix- shows features of chronic specific cervicitis.
• Body- shows proliferative endometrium and unremarkable myometrium.
DIAGNOSIS:
Infra vaginal elongation of cervix for vaginal hysterectomy with pelvic floor repair
OPERATIVE PROCEDURE DONE:
Vaginal hysterectomy with pelvic floor repair

8. THERAPEUTIC MANAGEMENT: Pre operative medications
Medications D1 D2 D3 D4 D5
C. Doxycycline 100 mg 1-0-1     
T. Flagyl 400 mg 1-1-1     
T. Pantoprazole 40 mg 1-0-0     
T. Paracetamol 500 mg 1-1-1 -    
T. FST/ Vit C 1-0-1 -    
T. BCT/ Ca 0-1-0 -    
T. Eltroxin 50 mcg 1-0-0 -    

9. Medications D7 D8 D9 D10 D11 D12 D13
T. Eltroxin 50 mcg 1-0-0       
Inj. Taxim 1g IV BD    - - - -
Inj. Metrogyl 500 mg IV TDS    - - - -
Inj. Pan 40 mg IV BD       
Inj. Tramadol 2cc IM BD  - - - - - -
T. Taxim O 200 mg 1-0-1 - - -    -
T. Ibenplus -      
T. Metrogyl 400 mg 1-0-1 - - -    -
T. Oflox OZ 1-0-1 - - - - -  -
Post operative medications:

10. ADVICE ON DISCHARGE:
T. Livogen 1-0-1 x 1 week
T. Shelcal 0-1-0 x 1 week
T. Vit C 1-0-1 X 1 week
T. Eltroxin 50 mcg OD

11. SOAPANALYSIS
SUBJECTIVE:
A 41 years old female came with a c/o mass descending pv since 3 years
C/O white discharge p/v since 3 years
C/O difficulty in walking and standing since 3 years
H/O difficulty in sexual intercourse
H/O burning micturition for 4 months
H/O low back pain for 2 months
OBJECTIVE:
From the local examination it seems that cervix lying outside the introitus, cervix hypertrophied .
From lab data it seems that bilateral pleural effusion is present , TSH- 6.239 mIU/l is higher than the normal range [0.5-5 mIU/L]
From microscopic examination of uterus with cervix, cervix- shows features of chronic non specific cervicitis.
ASSESSMENT:
Based on evaluation of clinical findings , patient was diagnosed with infra vaginal elongation of cervix for vaginal hysterectomy with pelvic floor
repair.

12. PLAN:
Generic name of drug Dose Category ROA Frequency
Doxycycline 100 mg Anti bacterial PO BD
Metronidazole 400 mg Anti infective PO TID
Pantoprazole 40 mg Anti ulcerant, PPI PO OD
Acetaminophen 500 mg Anti pyretic, NSAID PO TID
Levothyroxine 50 mcg Thyroid hormone PO OD
Cefotaxime 1 g Anti bacterial IV BD
Metronidazole 500 mg Anti infective IV TID
Pantoprazole 40 mg Anti ulcerant, PPI IV BD
Tramadol 2cc Opioid analgesic IM BD
Ibuprofen + acetaminophen 200 mg+ 325
mg
Analgesic, anti pyretic, NSAID PO BD
Cefotaxime 200 mg Anti bacterial PO BD
Ofloxacin+ornidazole 700 mg Anti bacterial, anti protozoal PO BD

13. CRITICAL EVALUATION OF PRESCRIPTION:
QUESIONARIES YES NO
Needing pharmacotherapy and not receiving it - No
Taking or receiving or wrong drug - No
Taking or receiving too much of drug content - No
Taking or receiving too little of the drug content - No
Experiencing adverse effect of drug - No
Experiencing drug interaction Yes -
Not taking or receiving the drug prescribed - No
Taking or receiving the drug for no valid indication - no

14. PHARMACIST INTERVENTION:
DRUG - DRUG INTERACTION:
Levothyroxine + pantoprazole
Taking levothyroxine with pantoprazole may interfere with absorption of levothyroxine
and reduce its effectiveness.
PATIENT COUNSELING:
• Take the multi vitamin tablets and supplements regularly.
• Take plenty of water, avoid lifting heavy weights for 6 months.
• Use good lifting posture
• Manage your abdominal body fat levels to avoid loading your pelvic floor
• Lift from waist height – avoid lifting from below your waist where possible
• Consume necessary amount of food before taking this medications.