This case presentation is for a 45-year-old primigravida woman at 32+2 weeks of gestation who came in for prophylactic steroid coverage due to her advanced maternal age and IVF conception. Her pregnancy has been uncomplicated with good prenatal care. On examination, her vital signs were normal and her pregnancy appeared to be progressing well.

1. CASE PRESENTATION
MODERATOR: DR DIVYA TK
PRESENTOR: DR RUSA MITRA

2. •Name: Mrs Ashanamdev
•Age: 45years
•Education:12th standard
•Occupation: Homemaker
•MRD No:2042771
•IP No: 2309090151
•Date of Admission:9/9/2023
•Husband’s name: Subhas
Chandra
•Age: 50 years
•Occupation: electrical
mechanic
•Address: Makali,nisarga layout
•Socio-economic status: lower
middle class.( according to
Kuppuswamy classification)

3. •OBSTETRIC SCORE: Elderly primigravida with h/o 8MOA
LMP: 12/2/2023
EDD: 19/11/2023
POG -33+2WOG
IVF (embryo transplant) -27/2/2023 (S.EDD- 13/11/23)
C.POG- 32+2WOG

4. CHIEF COMPLAINTS
•Came for prophylactic steroid coverage in view of increase maternal age
and IVF conception

5. HISTORY OF PRESENT
ILLNESS
• Elderly primigravida with h/o 8 months of amenorrhea, appreciating fetal
movement well
• Came for prophylactic steroid coverage in view of increase maternal age and
IVF conception

6. • No h/o bleeding pv, no h/o leak pv,no h/o burning micturation,no h/o white
discharge pv, no h/o fever
• No h/o blood transfusion
• No h/o headache, blurring of vision , epigastric pain, swelling of legs.

7. OBSTETRIC HISTORY
•Married life: second marriage -2 years back -non consanguineous
•Previous marriage in 1994 - husband died in 2012 (I/v/o renal failure) -
widow for 9 years
•OBSTETRIC SCORE : Primigravida
•1st pregnancy :present pregnancy

8. 1st trimester
• Spontaneous conception
• Pregnancy diagnosed with UPT at nearby clinic at 1 and half month of amenorrhea.
• Dating scan done at 9 weeks of gestation.
• Folic acid tablets taken.
• Patient was on tab aspirin 75mg OD , tab progesterone BD, dyhydrogestrone 10mg TID
• Anti D prophylaxis taken
• NT/NB scan done and was within normal limits
• Inj TT 1st dose taken at 3MOA
• No H/O excessive vomiting, pain abdomen, bleeding PV, fever with or without rashes, burning micturition , spotting
pv or white discharge pv
•No H/O radiation exposure, teratogenic drug intake
HISTORY OF PRESENT
PREGNANCY

9. 2nd TRIMESTER:
• Quickening felt at 5MOA
• Anomaly scan done in 22+5 weeks - no anomalies noted
• Iron and calcium tablets taken regularly
• Inj TT 2nd dose taken at 5 MOA
• Tab hydroxyprogesterone taken weekly
• Patient was advised to get husband’s blood group checked which is O positive
• No h/o pain abdomen, bleeding pv ,leak pv
• No H/O headache, blurring of vision, epigastric pain, swelling of legs

10. 3rd TRIMESTER
• Continue to perceive fetal movement well
• Iron and calcium tablets were taken regularly
• Growth scan done was done at 7MOA and was within normal limits
• Indirect combo test done which came negative
• No h/o bleeding pv, leak pv,burning micturition
• No H/O headache, blurring of vision, epigastric pain, swelling of legs.

11. MENSTRUAL HISTORY
•LMP: 5/11/2022
•PREVIOUS MENSTRUAL CYCLES
iregular,moderate volume
Duration: 2-4days
Cycle:2 months
Not associated with passage of clots or dysmenorrhea
Changing :2-3 pads/day

12. • Diagnostic hystroscopy done on 21/1/2023
•Not a known case of hypertension, diabetes mellitus,
hypothyroidism,bronchial asthma, ischemic heart disease, epilepsy
•No previous blood transfusion.
PAST HISTORY

13. FAMILY HISTORY
•No history of hypertension, diabetes mellitus, hypothyroidism,bronchial asthma,
ischemic heart disease, epilepsy in the family
•No history of developmental anomalies in the family
•No history of twin gestation

14. •DIET: mixed
•APPETITE: good
•SLEEP: normal
•BOWEL AND BLADDER: normal and regular
•HABITS: nil
•Lactose intolerant
PERSONAL HISTORY

15. GENERAL PHYSICAL EXAMINATION
Conscious, cooperative and
well oriented to time, place &
person
VITALS:
•Pulse Rate: 88bpm
•Blood Pressure:130/70mmhg
•Respirate Rate: 18 cpm
•Temperature: 97.4F
Pre- Pregnancy weight: 60kg
Current weight: 67kg
Height:160 cm
BMI: 24kg/m2

16. •No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema
•Breast, Thyroid & Spine appear clinically normal

17. •CARDIOVASCULAR SYSTEM: S1, S2 + , no murmurs
•RESPIRATORY SYSTEM: B/L Normal Vesicular Breath sounds + , no added sounds
•CENTRAL NERVOUS SYSTEM: No focal neurological deficit
SYSTEMIC EXAMINATION

18. •PER ABDOMEN
INSPECTION
Uniformly distended
Linea nigra present
Stria gravidarum present
Umbilicus everted
Hernial orifices intact
No scars or dilated veins
PALPATION
Uterus ~30-32weeks
Fundal grip- broad, soft, non ballotable, s/o breech
Lateral grip-
Right side: multiple knob like structures s/o limb buds
Left side: smooth, firm, curvilinear structure s/o spine
Pelvic grip- hard, round, ballotable, s/o head
Cephalic presentation
AUSCULTATION
Fetal heart rate 146bpm on left spinoumbilical line

19. • Elderly primigravida with 32+2weeks of gestation with Rh negative
status for steroiding.
PROVISIONAL DIAGNOSIS