1. A 23-year-old woman at 30 weeks gestation with twin pregnancy and polyhydramnios was referred for management. She had discomfort from inability to sit for long periods. 2. She received dexamethasone injections and planned amnioreduction after steroid administration to prepare lungs for possible preterm delivery at 32 weeks. 3. Her exam found a gravid uterus consistent with twins, no other issues, and ultrasound confirmed twin pregnancy with polyhydramnios causing discomfort.

1. DAY DUTY REPORT
3rd october 2023
Dr TUYISENGE AIME PATRICK
Dr HAFASHIMANA EMMAUEL
INT:

2. 43y.0 G4P3003 @39w1d ,latent phase of labor on 2x uterine scar admitted for c section ID 73589
CC: lumbar pelvic pain
HPI: symptoms started 4 hours prior to our consultation
regular lumbar pelvic pain
ROS: No PV bleeding, FM+,no PV bleeding
ATCDs:
 G4P3003 LMP:02/01/20223
 G1 SVD ,G2 Csection for NRFH 2009 ,G3 C section
for TOLAC denial 2013
 8ANC and were uneventful
 BG B+
 HIV negative
 TORCH: Neg
 no chronic illness
O/E: stable
BP:124/75, HR:88, RR:19, T:36.1, SPO2: 98% RA
GCS:15/15,
RS: Not in respiratory distress , clear lungs.
CVS: warm extremities, S1&S2 are audible
GIT: Gravid Uterus, pfanestiel scar, 1 UC , SFH:
36cm, FHR:140BPM
GUS: dilatation 1cm ,effacement 60%,soft,descent
5/5
MSK: No edema, no deformity
U/S : SIUP,cephalic presentation ,EFW 3.4 kg
Anterofundic placenta,MVP 5cm
Labs:
Hb:
Hct:
Plt:
BG:
HIV:
Hep B:
Hep C:
Glycemia:
FP: immediate IUCD
ASS: 43y.0 G4P3003 @39w1d , with feature of latent
phase of labor on 2x uterine scar
Plan:
- Admit the patient
- Prepare for c section
- Informed consent
- Informed theater
Evolution:

3. 38 y.0 G1P0010 with uterine fibroid admitted for myomectomy before IVF ID 455017
HPI: she had secondarly infertility and consulted
MEDHEAL for IVF and all screening and egg
stimulation she was found to have uterine fibroid and
was reffered for myomectomy before doing IVF
ROS: sometime abdominal pain, no PV bleeding
ATCD:
• G1P0010 . LMP unknown
• Had abortion @28years
• Secondarily infertility for 8 years
• Had myomectomy in 2017 andlaparatomy for
TOA in 2008
• Blood group B+,HIV negative
• No other known chronic disease.
• 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; No added
sounds
ABD: distended abdomen ,with irregular masses,uterine size
16w
GUS: not done
MSK: no edema, no deformity.
U/S : empty uterus with pedunculated uterine fibroid the
biggest measure 9x9cm
Labs:
Hb:
Plt:
Glycemia:
HIV:
HBsAg:
HCV;
FP: interval IUCD
ASS: 38 y.0 G1P0010 with features of pedunculated
uterine fibroids admitted for myomectomy before
IVF
Plan:
• Admit the patient
• do labs
• Anesthesist visit
• Myomectomy tomorrow
• Book 3 unit of PRBCs
Evolution:

4. 46 Y.O GO with symptomatic polymyomatous uterus admitted for myomectomy with possible TAH, ID 455024
CC :abdominal distension and abdominal pain
HPI:
symptoms started 2 years ago with progressive abdominal
distension ,followed by abdominal pain ,consulted DH and
was referred here for better management
ROS: no AUB, no GI nor urinary tract symptoms,no weight
loss
ATCD:
• GO
• Not married ,didn’t try to conceived
• HIV: neg, BG: unkown
• No DM, No HTN,
• No surgical hx
• Smoking -,alcohol -
O/E: good general status
BP:133/87, HR:100btm, T 36.4, SPO2: 97, RR: 18
RS :No RD ,clear lung
CVS :S1&S2 audible no murmur
ABDOMEN: distended abdomen with ireegular
masses,mobile ,uterine size 20w
MSK :No derformity ,no oedema
U/S: uterus not seen ,multiple uterine fibroid with the
biggest 7x8cm
No free fluid in abdomen
Labs:
Hb:
Plt:
HIV:
BG
Urea
Crea
Alt
asat
ASS:
46 Y.O GO with features of symptomatic polymyomatous
uterus admitted for myomectomy with possible TAH
Plan:
• Admit the patient
• Anesthetist visit
• Program myomectomy with possible TAH
Evolution:

5. 23 YO G1P0@30w0d by u/s with MCMA Twin pregnancy and polyhydramnios admitted for steroid and amnioreducation ID 461283
Cc: referred from DH
HPI: she consulted dh and was found to have twin pregnancy and
polyhydramnios and was referred here for further investigation
and management
ROS: FM+,no RD ,no lpp,no gush of fluid,no pv bleeding,inable
to sit long time due to discomfort
ANTECENTS:
 G1P0 ,LMP 23/02/2023,
 3 ANC (2@HC ,1@DH) all were uneventfully
 TORCH screening not kown,
 Iron supplementation
 No DM,no HTN
 Hiv neg,BG unkown
 No surgical hx
 Alcohol-,Tobacco-
P/E: Stable,but no able to sit for long time
BP: 120/87.130/82 , H: 100, RR:20, T:36.5,
SPO2: 98
GCS:15/15
RS: Not in Respiratory distress, lungs are
clear
CVS:, S1&S2 audible.
ABD: Gravidic uterus, SFH 34cm ,no UC
GUS: closed cervix
MSK: MCMA twin pregnancy, no
intermembrane seen,both twin has +CA
EFW1 1490g,EFW2 1550g,with
polyhydrmnios
Labs:
Hb
Plt
BG:
Hep B
Hep C
TORCH screening
Glucemie
Hbc1
23 YO G1P0@30w0d by u/s with MCMA Twin pregnancy and
polyhydramnios causing mother discomfort admitted for steroid
and amnioreducation
Plan:
• Admit in ward
• IM dexamethasone 6mg 12hourly
• Amnioreducation after steroid
• Delivery @32wod
Evolution: