This patient presented with bleeding at 33 weeks and 3 days of gestation and was diagnosed with Placenta Previa Type IV. She underwent an elective lower segment Caesarean section to deliver a baby boy in an uncomplicated procedure. She had a history of gestational diabetes and HbE thalassemia trait. The baby was admitted to special care for monitoring due to low birth weight. She was discharged with medications and instructions to follow up in one week and six weeks.

1. NAME R/N NO. I/C NUMBER DATE OF BIRTH
x xx xxxx 04/12/1986
ADDRESS SEX DATE OF ADMISSION DATE OF
DISCHARGED
Panchor, Muar Female 17/11/2021 07/12//2021
FINAL DIAGNOSIS
Day 3 post ELLSCS uncomplicated for Placenta Previa Type IV with underlying gestional
diabetes melitus, HbE thalassemia trait and anemia in pregnancy
SUMMARY
Known case of GDM on treatment. Presented with a complaint of bleeding per vagina at 33
weeks + 3 days diagnosed as Placenta Previa Type IV. Baby boy delivered by elective lower
segment Caesarean section with transverse incision, uncomplicated with estimated blood
loss of 700 CC.
HISTORY OF PRESENTING ILLNESS
GDM diagnosed at 18 weeks. Started on Tab Metformin 500mg OD at 20 weeks increased
to 1g BD at 32 weeks. Started on S/C Insulatard 8u at 34 weeks. GBS carrier. Diagnosed
with HbE Thalassemia trait since last pregnancy. Baby boy delivered through ELSCS. Birth
weight of 2.56kg. Baby was admitted to special nursery care for further evaluation and
monitoring in view of low birth weight.
PAST HISTORY
First pregnancy was in 2018. Delivered a full-term baby boy via spontaneous vaginal
delivery. Antenatal period was uneventful. However, she developed primary postpartum
hemorrhage due to stage 3 perineal tear. The estimated blood loss was 1L. the perineal tear
was repaired in operation theatre. She was transfused with 2 pints of packed cell. Birth
weight was 3.25 kg. He was admitted to NICU for 3 days due to neonatal jaundice. He was
breastfed for 1 year and a half. Currently, 3 years old well and healthy.
PHYSICAL EXAMINATION
Alert, conscious, BP is 130/85 mm Hg, PR is 82 bpm, T is 37o
C, PS is 1, abdomen is soft
and non-tender, uterus is well contracted and at 16 weeks, wound is clean with no
hematoma, no calves tenderness, lungs are clear.
INVESTIGATIONS
Hb is 10.6 g/dL, TWC is 9.14 x 103
/uL, PLT is 305 x 103
/uL
TREATMENT

2. Allow discharge today
Discharge with
T. PCM QID/PRN for 5 days
C. Ponstan 500mg TDS for 5 days
S/C heparin 5000U BD to complete at Day 10 post op
Repeat FBC on Day 7
Continue Tab. Metformin 1g BD ans S/C Insulatard 8u ON. To review blood sugar at KK in
1/52
TCA KK 6/52 for contraception and Pap smear