Summary of night duty of residency in obs gyne

1. DAY DUTY 02ST AUGUST 2023
DR.Alice
DR.NSENGIMANA ETIENNE
DR.HAFASHIMANA EMMANUEL
Interns: Parfait Mwizerwa
Ornella Celine
Under supervision: Dr. Bagambe Patrick

2. 30 y.o G1P0 @39W6D ,PREECLAMPSIA WITH SEVERE FEATURE ON BG OF CHD(PDA)REPAIRED. ID 619043
CC: high BP on bg CHD
HPI: she was having uncomplicated pregnancy and yesterday she
was going to NEMBA DH for follow up (ANC) and she was found
to have high BP 161/110 called RUHENGELI RH for referral and
specialist told them she may need ICU after delivery ,advised them
to refer her here in high setting .was give hydralazine, nifedipine
20mg,aldomet 500mg , Mgso4 and referred here for better
management
ROS : FM+,no headache,no epeigastric pain ,no blurred vision
ATCD: G1P0
LMP 26/10/2022
She did 6ANC at (4 at HCand 2 at DH were uneventful
• Iron supplements given
• TORCH screening –
Past Medical Hx: CHD (PDA ) was diagnosed in 2022 march she
was in heart failure at that time
Past surgical Hx: PDA ligation at KFH in 09 march 2022
After surgery was put on Lasix p.o 40mg bid.pen v250mg
tds,carviderol p.03,125od,enarapiril po 2.5 mg od and was stooped by
cardiologist in September by cardiologist
O/E: Stable;
BP:188/108 , HR:108, RR: 18, T:36,1 SPO2: 98%
CNS: Fully awake, GCS:15/15
RS: No RD , clear lungs.
CVS: warm extremities, S1&S2 are audible;
systolic murmur grade 2 in P area
ABD: Gravid Uterus, SFH:36cm, no palpable
uterine contractions, FHR:134bpm,
GUS: has foley catheter closed cervix,mid
position ,no effacement,satation -3
MSK: no edema, no deformity;
U/S : SIUP, cephalic presentation , EGA 39W4D,
mvp 5cm , EFW 3,4kg, Antero-fundic placenta,
FHR: 134bpm
Normal umbrical Doppler
CARDIACC U/S :no flow in repaired
,EF:65%,severe PR,PHT :85 msec
Labs:
Hb:
Plt:
Glycemia:
HIV:
HBsAg:
HcV;
BG:
Urea
Crea
Alat
Asat
Protenuria
LDH
FP: not decided
ASS: 30 Y.0G1P0 @39W6D with pereclampsia with severe features
on bg PDA repaired
Plan: -Admit the patient in labor ward
Iv hydralazine 5mg PRN ,target BP <160/110
P.O nidfedipine 20mg bid
IV mg 1g/h till 24 after delivery
-Do NSTfor 30minutes if reactive,
-Induction of labor by cytotec 50ucg 4hrly PO, TD:
6 doses
- Monitoring labor progress
Evolution:

3. 25 y.o G1P0 @41 W0D BY date scheduled for IOL ID 682141
CC come for IOL
HPI: she was followed at HC for ANC and was not
having sign of labor on given EDD and consulted here in
OPD and scheduled for IOLtoday
ROS: FM++, no gush of fluids, no PV bleeding
ATCD: G1p0. LMP 1/10/2022
6ANC at HC ,1 at CHUK
• Iron supplements given
• TORCH screening –
• HIV negative
• Blood group O rhesus negative
• No surgical Hx
• No known chronic disease. No known allergies
O/E: Stable
BP:127/76 , HR: 92, RR:18, T:36, SPO2: 97%;
RR:20
CNS: Fully awake, GCS:15/15
RS: No RD ,clear lungs.
CVS: warm extremities, S1&S2 are audible;
No added sounds
ABD: Gravid Uterus, SFH:37cm, FHR
139bpm,no UC
GUS: closed cervix ,mid position,effacement
<30%,firm,sation -3
MSK: no edema, no deformity; the extremities
are warm
U/S : SIUP, cephalic presentation , EGA
38W5D, AFI 7cm, EFW 3.3kg, Antero-fundic
placenta, FHR: 139bpm, BPP 8/8
Labs:
Hb:
Plt:
Glycemia:
HIV:
HBsAg:
HcV;
BG:
FP: not decided
ASS: 25 y.o G1P0 at 41w0d scheduled for IOL Plan:
- Admit the patient in labor
-do NST if reactive
Stat IOL with p.o cytotec 50mcg 4hourly (max
6 doses)
- Monitoring labor progress
Evolution:

4. 27 y.oG3P1011 @38w6d by early U.S on bg of 1 x uterine scar scheduled for C/SECTION ID 554795
CC: progrmmed for c section
HPI: she was followed here for ANC then was scheduled for ERCD on
03.08.2023
ROS: FM++, no gush of fluids, no lpp
ATCD: G3P1011. LMP unkown
EDD 10.08.2023 byearlyU.s
1 st pregnancy abortion at 9weeks
2nd C section M 3K in 2022 for NRFHR
6ANC at CHUK and all were uneventfully
• Iron supplements given
• TORCH screening –
SHX C SECTION IN 2022
No other surgical hx
No known chronic disease.
Blood group A -
No known allergies
O/E: Stable
BP:117/76 , HR: 92, RR:18, T:36, SPO2: 97%; RR:20
CNS: Fully awake, GCS:15/15
RS: No RD ,clear lungs.
CVS: warm extremities, S1&S2 are audible; No added
sounds
ABD: Gravid Uterus, SFH:35cm, FHR 139bpm,no uc
,pfanestiel scar
GUS: closed servix
MSK: no edema, no deformity; the extremities are warm
U/S : SIUP, cephalic presentation , EGA 38W5D, mvp 4cm
, EFW 3.3kg, Antero-fundic placenta, FHR: 139bpm, BPP
8/8
Labs:
Hb:
Plt:
Glycemia:
HIV:
HBsAg:
HcV;
BG:
FP: not decided
ASS:27 y.oG3P1011 @38w6d by early U.S on bg of 1 x uterine scar
scheduled for C/SECTION
Plan:
- Admit the patient
- Do labs
-anesthetist visit and program for c section on 03.08.2023
- Monitoring FHR
Evolution

5. 34 Y.0 G4P2011 @ 38W6D on bg of 1x uterine scar by date scheduled for C SECTION ID 508389
CC: programmed for c section
HPI: she was followed here for ANC and then
programmed for c section on 03.08.2023
ROS: FM++, no gush of fluids,no lpp ,nopv bleeding
ATCD: G4P2011
lmp 03.11.2022
1st SVD asiphyxia died at 7month
2nd C section in 2021
for maternal request due to death of fisrt child 3rd
brighetd ovum
5ANC at CHUK and all were uneventfully
BG Orh positive
HIV negative
• Iron supplements given
• TORCH screening –
• No surgical Hx
• No known chronic disease. No known allergies
O/E: Stable
BP:116/76 , HR: 98, RR:18, T:36, SPO2:
97%;
CNS: Fully awake, GCS:15/15
RS: No RD ,clear lungs.
CVS: warm extremities, S1&S2 are audible;
No added sounds
ABD: Gravid Uterus, SFH:35cm, FHR
139bpm,NO UC palpated
Pfanesntiel scar
GUS: closed cervix
MSK: no edema, no deformity; the
extremities are warm
U/S : SIUP, cephalic presentation , EGA
39W3D, AFI 3cm, EFW 3.5kg, Antero-fundic
placenta, FHR: 139bpm, BPP 8/8
Labs:
Hb:
Plt:
Glycemia:
HIV:
HBsAg:
HcV;
BG:
FP: not decided
ASS: 34 Y.0 G4P2011 @ 38W6D by date on bg of 1x
uterine scar and poor obstetrical hx scheduled for C
SECTION
Plan:
- Admit the patient
- Anesthesit visit and program for c section
on 03.08.2023
- Monitoring FHR
Evolution

6. 30Y.O G2P1001 @40W5D by DATE ,latent phase of labor on bg of 1x uterine scar ID 441331
CC: Lumbopelvic pain
HPI: she was followed here at CHUK and was given EDD as
usual then at that time she skipped followup to try to see if she
can have spontenous labor ,on 1st august she reconsulted OPD
and scheduled for C section on 03,08,2023 and then the night
she started to have LPP stayed at home and consulted at day
time strongly requesting for TOLAC
ROS: FM+++, no gush of fluids, no PV bleeding
Has llp
ATCD: G2P1001. LMP 20/10/2022
1st C/S for failed IOL 2019
5ANC at CHUK and all were uneventfully
• Iron supplements given
• BG Orh positive
• HIV negative
• TORCH screening –
other surgery: operated on R fore arm for osteomyelitis in
2009
• No known chronic disease. No known allergies
O/E: Stable
BP:109/76 , HR: 61,, T:36, SPO2: 97%; RR:20
CNS: Fully awake, GCS:15/15
RS: No RD ,clear lungs.
CVS: warm extremities, S1&S2 are audible; No
added sounds
ABD: Gravid Uterus, SFH:35cm, FHR
139bpm,parapable U.C 2/10 weak
Pfanenstiel scar
GUS: cervix dilatation 3cm,soft,effaced
@80%mid position ,station -1 bishop score
MSK: no edema, no deformity; the extremities are
warm
U/S : SIUP, cephalic presentation , EGA 38W6D,
AFI 6cm, EFW 3.4kg, lateral -fundic placenta,
FHR: 139bpm, BPP 8/8 bpp 8/8
Labs:
Hb:
Plt:
Glycemia:
HIV:
HBsAg:
HcV;
BG:
FP: IUCD
ASS: 30Y.O G2P1001 @40W5D by DATE ,latent phase of
labor on bg of 1x uterine scar
Plan:
- Admit the patient in labor
- Sign conset for TOLAC
- Continous CTG
- Monitoring labor progress
Evolution:

7. 30 YO G1P0 at 14W0D by dates with features of degenerating uterine fibroid admitted for hydration, pain
management and investigations (308600)
CC: Right lower quadrant pain, fever and
headache.
HPI: Symptoms started 1 week prior to our
admission with mild to moderate right lower
quadrant pain then since 1 day ago she had acute
onset of severe right lower quadrant pain followed
by headache and fever, associated with
vomiting(2x). She took paracetamol po and
consulted for management. She denied dysuria,
vaginal discharge/bleeding, stool: positive
ANTECEDENTS: G1P0, LMP: 25/04/2023
1ANC at HC
PMSHX: No chronic diseases reported, no surgical
hx
No recent hx of malaria
BG: Arh+
P/E: weak, but full awake, BP:125/86, HR:125bpm,
RR:20, SPO2: 100% on RA, To: 36.5, pain score: 6/10
H&N: Dry buccal mucosa, no pallor
RS: No respiratory distress, clear lungs
CVS: warm extremities, regular tachycardia S1 and
S2 are audible, no added sounds.
Abd: mildly distended abdomen, right lower
quadrant tender mass, firm, moves with uterus,
18weeks size, no rebound. Uterus of 14weeks size.
GUS: normal
MSK: Normal
U/S: SIUP, cardiac activity positive, EFW:105+/-
66grs, GA:15weeks, Amniotic fluids:+, pedunculated
uterine mass with mixed echogenicity, 7.5cmX5cm,
taking color, we could see continuity of serosa from
uterus to the mass.
Lab:
WBC:
Neutrophils:
Hb:
PTL: BG:
Cr: urea:
K: Na: cl:
Hiv:
HepB&C:
Glycemia:
Malaria:
Urinalysis: pending
ASS: 30 YO G1P0 at 14W0D by dates with features
of degenerating uterine fibroid admitted for
hydration, pain management and investigations
DDX: Acute appendicitis(less likely)
Plan: Admit the patient
Iv RL 2L bolus, then 120ml/hr for 6hours
Tramadol IM 50mg stat
Paracetamol po 1g TDS 5/7
Tramadol po 50mg TDS 5/7
Encourage oral fluids
Monitor vital signs 6hrly
Evolution:

9. 41 YO G4P3003 at 34w5d by date admitted with severe polyhydramnios with IUGR and multiple congenital anomalies
ID: 694214
CC : shortness of breath and Overdistended
abdomen
HPI: Symptoms started 3 mo ago with
progressive abdominal distention where 5 days
ago she developed severe lumbo-pelvic pain
associated with shortness of breath. She consulted
Remera rukoma DH where she was given
painkillers and Dexamethasone then transferred
her in our setting for further management.
ROS: No ROM, no pv bleeding, FM+
PMH/OBS
LMP: 02/12/2022 GA: 34w5d
G4P3003 G1,G2,G3 all were SVDs
5 ANCs, 3 ANC at HC+2ANC at DH, Iron suppl.
No chronic disease, BG&Rh: unknown
P/E: Moderate respiratory distress
BP 138/78, HR:90 ,T: 36.3℃,RR:23;SPO2:95%
RS: Moderate RD, Lungs were clear, B air entry
CVS: S1, S2 audible with no added sounds
GIT: overdistended abdomen, Gravidic uterus , no
palpable contractions , SFH=40cm FHR=144bpm
GU: no gush of fluid, no pv bleeding, cervix closed
MSK: normal ,no pitting edema, no signs of DVT
Obs U/S: SIUP, EFW:1.2 kg, EGA:29w2d, FHR
145, head <3rd %, severe polyhydramnios, no
pouching over larynx/esophagus, clenched fist and
clubbing of hands, stomach shadow not visualized,
AVSD and single umbilical artery.
Labs:
Hb:
Platelets:
BG&RH:
HIV:
HBsAg:
HCV Ab:
Gly:
AST:
ALT:
FP: No decision yet
ASS:
41 YO G4P3003 at 34w5d by date admitted with
severe polyhydramnios IUGR and multiple fetal
congenital anomalies who presented with
respiratory distress
Plan
1.Admission in ward 2
2.Therapeutic amnioreduction to mild
polyhydramnios
3. Repeat MFM with U/S after amnioreduction
4. Wait for spontaneous labor, Counselling for poor
prognosis and complications
Evolution: