Case report in shift duty

1. Day DUTY REPORT
12nd NOV 2023
THEOGENE ,MFM
Dr LAZARE
Dr HAFASHIMANA
Intern Dr MURINDANGABO
intern liliane

2. 32 y.o G4P2012 @38W2D by early u.s with uterine dehiscence and IUFD ID 462621
CC: lumbar pelvic pain and severe abdominal pain
HPI: she has been followed at private clinic and did
3ANC here at RMH with EDD of 24.11.2023
equivalent to GA of 38w2d and was having RDV for
elective cesarean section on 20.11.2023,then 3 hours
prior to our consultation had lumbar pelvic pain and
followed by severe abdominal pain ,and consulted in
the morning here for management
ROS:, no PV bleeding ,no hx of trauma ,no gush of
fluid ,last FM was last night
ATCDs:
 G4P2012 EDD 24.11.2023 by U.S @11weeks
 GA38w2d
 Did 6ANC (3private clinic ,3RMH)
 2X UTERINE SCAR,G1 NRFHR,G2 RCD
 BG unknown
 HIV negative
 No chronic diseases
O/E: in severe abdominal pain and intermittent pain
7episode in 10 min
BP:114/65, HR:131, RR:19, SPO2: 98% RA GCS:15/15,
RS: Not in respiratory distress , clear lungs.
CVS:, S1&S2 are audible no murmur
GIT: gravid uterus , phannetiels scar weak uterine
contraction not comparable to severity of pain
FHR negative on Doppler
GUS: no active pv bleeding, closed cervix
MSK: No edema, no deformity
U/S single intrauterine pregnancy, no cardiac activity,
cephalic presentation
Efw 3.9kg anterofundic placenta ,no free fluid in abdomen
Labs:
Hb: 12.9
Plt:198
BG:
HIV:neg
Urea 4.5
Crea 46
Glycemia:
Na 137
K 4.2
Cl 108
Intra op; uterine
dehiscence and IUFD
ASS: 32 y.o G4P2012 @38W2D by early u.s with
feature of abruption placenta vs uterine rupture
complicated to IUFD
Plan:.Admit the patient
- Iv line and iv fluid
- Emergency cesarean delivery with possible
hysterectomy
- Sign informed consent and family counselling
Evolution: normal
vital sign

3. 30 Y. G2P0010 ,PROM @39w5d admitted for IOL ID 334314
CC : spontaneous gush of fluid
HPI spontaneous gush of fluid 7 hours prior to our
consultation while she was in bed
ROS: no fever,no pv bleeding ,FM+,no pain
ATCD: G2P0010 ,LMP 07.02.2023
• GA 39W5D
• 6ANC @private clinic
• TORCH screening negative
• HIV negative
• No DM nor THN
• ,Blood group O+,
• No known allergies
O/E: Stable
BP:105/70 , HR: 82, RR:18, T:36.5, SPO2: 98%;
CNS: Fully awake, GCS:15/15,
RS: No RD ,clear lungs.
CVS: warm extremities, S1&S2 are audible
ABD: gravid uterus ,SFH 35cm,FHR 132
GU :pooling test positive ,closed cervix
MSK: no edema, no deformity.
U/S : single live fetus ,cephalic EFW 3,5kg
Anterofundic placenta MVP 3cm
Labs:
Hb: 12.3
Plt: 282
glucemie: 4.3
BG O+
Hep B positive
Hep c negative
Ass 30 Y. G2P0010 , @39w5d with features of PROM
admitted for IOL
UWAMAHOR AGNES
Plan:
-admit
 DO NST if reactive ,start IOL with p.o cytotec 50mug
4hourly 6 dose
 IV ampicillin 2g 6 hourly till delivery
Vaccination of newborn and immunoglobulin
Evolution: stable

4. 41 YO G0 with symptomatic fibroids admitted for TAH+ BS
CC: heavy and prolonged menses
HPI: symptoms started 3 months ago as prolonged menses
lasting for 12 days and heavy bleeding during periods
associated with dsymenorrhea. She consulted here and
IAUS showed polymyomatous uterus and then was
scheduled for hysterectomy.
ROS: no headache no dizziness no fever but she is in
periods.
ATCD:
• G0
• LMP : 3/11/2023
• no chronic disease hx, HIV negative
• SHx: no surgical history
O/E: Stable
BP: 121/75, HR: 69
CNS: Fully awake, GCS:15/15
RS: Chest expands bilaterally, Not in
RD
CVS: Warm extremities, S1&S2 are
audible
ABD : 18 weeks uterine size,
GUS cervix and vagina looks normal
MSK: No edema
U/S : multiple uterine fibroid
The biggest 6x5cm
Endometria strip seen and distorted
Labs:
Hb
Plt:
Glycemia:
HIV: neg
BG
ASS:
a 41 YO G0 with symptomatic fibroids admitted for
TAH+BS.
Plan:
Admit the patient
Do lab investigations
sign informed conent
prepare for TAH+BS
Evolution: ready
for surgery

5. 35 YO G3P1011 @39W0D by dates admitted for C/S on 1x uterine scar.
CC: Scheduled C/S
HPI: she had all ANCs here and on the last visit she was
scheduled for C/S.
ROS: No fever,no headache, no contractions, no PV
bleeding,no gush of fluid, FM+
ATCD:
• G3P1011, LMP:14/2/2023 , GA: 39W0D
• 1X uterine scar on G1 for placenta previa
PMHx: No chronic disease hx
SHx: 1 previous C/S
O/E: Stable
BP: 128/86, HR:67 , RR:16 , T:36.7,
SPO2: 98%
CNS: Fully awake, GCS:15/15
RS: Chest expands bilaterally, Not in RD
CVS: Warm extremities, S1&S2 are audible
ABD: gravidic uterus SFH 32cm, no uterine
contractions,
GUS: cervix is closed and firm
MSK: No edema
U/S : cephalic, antero-fundic placenta, 3,3 kg,
GA: 39W
Labs:
Hb
Plt:
Glycemia
HIV: Neg
HBsAg:
HepC
BG:
ASS: a 33 YO G3P1011 @ 39W admitted for
programmed C/S.
DX: early term pregnancy on 1x uterine scar.
Plan: admit
do requested labs
sign informed consent
prepare for C/S today.
Evolution: ready
for C/S

6. • 28 y.o G1p0 @39w3d latent phase of labor (dilation 2cm) ID Hb 14.0.plt: 311
BG B positive (mugeni rose)