The document presents a case of a 29-year-old multigravida woman, currently 10 weeks and 1 day pregnant, with blood group B-negative married to a B-positive husband. She has a history of one first trimester abortion and is asymptomatic during this antenatal visit. Examination reveals mild pallor but no significant abnormalities, raising concerns about potential Rh incompatibility in the current pregnancy.

1. CASE PRESENTATION
Rh NEGATIVE PREGNANCY
PRESENTATION BY-
Lakshmi Sudhanshu
Final Year
AFMC

2. PATIENT PARTICULARS
Mrs xyz
 29 year old
 Resident of Kondhwa
 Occupation: Housemaid
 Educated till Class 8th
 Blood group : B-ve
 Married for 5 years
 Socio Economic Status: Low Socioeconomic Status
(Modified Kuppuswamy scale)
 Informant Self; Reliability Good
HUSBAND
• Mr xyz 31 yr Old
•Blood group : B+ve
• Occupation: Farmer

3.  LMP: 28 July, 2020
 EDD: 24 April, 2021
 POG: 10 weeks, 01 day
 G3P1L1A1
 She has come with 10 weeks of
amenorrhea for her first antenatal visit
and is currently asymptomatic.

4. History of present pregnancy
 Spontaneous conception
 1st trimester
 diagnosed by UPT
 USG: Confirmed Pregnancy
 Routine ANC investigations have been advised;
reports awaited

5.  No h/o excessive nausea and vomiting
 No h/o fever with rashes
 No h/o bleeding PV or discharge PV
 No h/o pain abdomen
 No h/o burning micturition, increased frequency of
micturition
 No history of radiation or teratogenic drug exposure
 No easy fatigability

6. Obstetric History
 Married since 05 year
 Non-consanguineous marriage
 She is Multigravida, G3P1L1A1
 Currently at 10wk 01 days POG

7. No
.
Date
of
Pregna
ncy
Antenat
al
period
Labor
events
Method
of
delivery
puerperium baby
1. 2016
(at 25
yrs of
age)
_
uneventf
ul
_ Full term
Normal
vaginal
delivery
h/o costly
injection
administration
on 3rd day in
the upper arm
Baby
2.8 Kg
Cried at
birth,
Live and
healthy
2. 2018
(at 27
yrs of
age)
Spontan
eous
abortion
at 3rd
month
Spontan
eous
conceptu
s
delivery
Was managed
in village
No h/o
prophylactic
antiD was
given post
abortion

8. Menstrual history
 Age of menarche: 13 years
 Past cycles: Regular, 28-30days - followed by 3-4
days of menses
 Not associated with dysmenorrhea or passage of
clots

9. PAST HISTORY
 No major medical problem like HTN, DM, TB,
Asthma, Thyroid disorders, Epilepsy, Bleeding
Problems, or Drug treatment history.
 No surgical history
 No h/o blood transfusion

10. Family history
 No history of diabetes, hypertension, asthma, Tb,
blood dyscrasia, known hereditary disease in the
family
 No h/o children with congenital malformations
 No h/o twinning

11. Personal history
 No contraceptive used
 Diet: Mixed
◦ Calories required =2,500 kcals
◦ Calories intake = 2,100kcals
◦ Protein intake: adequate
◦ Calorie Deficit = 18%
 Appetite : Good
 Sleep / wake cycle : normal
 Bowel and bladder : regular
 No h/o any substance abuse, Smoking, alcohol
intake or high risk behaviour
 No h/o any known drug allergy

12. SUMMARY:
29 year old blood group B-ve multigravida,
G3P1L1A1, at 10 wk 01 day period of gestation,
married to B+ ve husband; spontaneous
conception, presented for routine ANC visit and
currently asymptomatic, with no other co
morbidities and no significant family history.

13. General Physical Examination
 Patient is conscious, co-operative and well oriented to time ,
place and person. Patient is moderately built and nourished.
Consent was taken and examined in presence female attendant
 Vitals :
◦ Patient is afebrile
◦ Pulse rate : 82 Beats/min in right radial artery which is regular in rhythm,
good volume , normal in character, no vessel wall thickening, equal on
both sides , no radioradial or radiofemoral delay and all the peripheral
pulses were palpable

14.  BP: 120/74 mmHg
 Respiratory rate : 16 breaths /min
 JVP: not raised
 Mild Pallor present,
 No Icterus, Clubbing, Cyanosis, Lymphadenopathy,
Pedal Edema
 BMI : 24.14kg/m2
◦ Height : 155cms
◦ Weight : 58kgs (Prepregnancy weight)
 Gait and spine appeared to be normal

15.  Orodental hygiene well maintained and no signs of
nutritional deficiencies
 No dilated veins over the neck
 Thyroid appears normal
 Breast- normal, no retracted or cracked nipples and no
palpable lump

16. Systemic examination
 CNS Examination:
◦ No Focal Neurological Deficits
 Respiratory System Examination:
◦ Bilaterally equal air entry, Vesicular breath sounds in all
areas of lung, no adventitious sounds

17. Cardiovascular Examination
◦ S1 and S2 heard, no murmur
◦ No parasternal heave/ thrills palpated
Abdominal examination
◦ Striae albicans seen
◦ Bowel sounds- present, normoactive in all four
quadrants

18. SUMMARY:
29 year old multigravida, G3P1L1A1, at 10 wk 01
day period of gestation; spontaneous conception,
blood group B-ve married to B+ve husband, h/o
1st term abortion (details unknown), presented for
routine ANC visit and currently asymptomatic.
On examination, mild pallor was seen, and no
other abnormal finding was there.

19. Provisional diagnosis
A 29 years old lady is G3P1L1A1 at 10 weeks 01 day of
gestation, blood group B-ve married to B+ve husband,
h/o 1st term abortion (details unknown), presented for
routine ANC checkup, with normal examination findings
highly suggestive of Rh incompatibility risk in present
pregnancy.