Mrs. Nasima, a 36-year-old housewife, was admitted to BSMMU hospital at 36 weeks and 4 days pregnant with complaints of less fetal movement. She has a history of hypothyroidism and gestational diabetes. Her blood sugar was controlled through diet but she was admitted for further management due to decreased fetal movement. On examination, she was anxious but stable, with a single fetus in longitudinal lie and cephalic presentation. The provisional diagnosis was a second pregnancy at 36 weeks and 4 days with gestational diabetes, hypothyroidism, and decreased fetal movement.

1. DR. BARUN RAI
General Gynaecology & Obstetrics
PHASE ‘B’ Resident.
BSMMU

2. Mrs. Nasima, 36yrs old housewife of a middle class family,
Para: 1(Home delivery), from Mohakali was admitted in
BSMMU on 25/09/2018 at 36 weeks & 4 days of pregnancy
with complain of :
 Less fetal movement.
 Known case of Hypothyroidism & Diabetes in pregnancy.

3. According to patient’s statement she was a regularly
menstruating woman with average flow and duration. Her
LMP was on 12/01/2018 and accordingly EDD would be
on 19/10/2018 which corresponds with her early USG. It
is her first issue since her second marriage . She was not
on regular antenatal check up was duly immunized
against tetanus.

4. Her first pregnancy was 19 years ago ( first marriage ), a male
baby was born at home ( 1999). She remarried in the year 2011.
Couple did not practice any contraceptive method till date.
She was diagnosed as hypothyroid 4 years back ( 2014 ) and
has been under medication ( Tab. Thyrox 50mg), ever since. Her
pregnancy was uneventful upto 35 weeks of gestation then her
fasting blood sugar level & 2 hours after 75gms of glucose was
found to be increased. 6.6mmol/l & 11.1mmol/l respectively.
(15/09/18). She was then advised to control blood glucose by
diet.

5. From then on her blood glucose was controlled with the diet
and her blood glucose was monitored regularly.
 Her bowel and bladder habit is normal. She gives no history
of burning sensation during micturation, excessive per
vaginal whitish discharge or vulvo vaginitis.
 She complained of less fetal movement since 1 day then
she was admitted to BSMMU for further management.

6.  Patient is nonalcoholic, nonsmoker.
 She gives no family history of diabetes, hypertension.
 Tab. Thyrox 50mg ( 1+0+0).

7.  With due consent and maintaining adequate privacy I
examined her on 27/09/18 and found shes anxious but
cooperative. She was mildly anaemic, non icteric, non
oedematous
 Her pulse-74b/min, BP-110/70mm of Hg, temp- normal.
 Thyroid gland was not enlarged.
 No accessible lymph node was palpable.
 Breast showed normal pregnancy changes.
 Cardio-respiratory system examination revealed no
abnormality.

8. On per abdominal examination
 Abdomen was uniformly enlarged. Umbilicus centrally
placed and everted. Striae gravidarum and linea nigra
were present.
 There was no other scar mark in abdomen.
 Symphysio fundal height was 36 cm which corresponds
with gestational age, abdominal girth was 102 cm.
 There was a single fetus with longitudinal lie, cephalic
presentation. Head was not engaged.
 Liquor volume seemed to be adequate.

9.  FHR was 136 b/min.
 Per vaginal examination : not done.
So from history and clinical examination, my provisional
diagnosis is
2nd Gravida @ 36 weeks +4 days of pregnancy with
Diabetes in pregnancy ( on diet ) with hypothyroidism with
less fetal movement.