NEW ADMISSION PRE ECLAMPSIA

seen patient on admission

known patient with pre eclampsia for the previous pregnancies
G4P3L3 GA-37 weeks by date
LNMP-22/10/2018
EDD-29/7/2019

came for regular antenatal visits found to have high bp of 159/72, 142/71,.No history of lower abdominal
pain, epigastric pain, headache or blurred vision.No history of pv leakage, bleeding or discharge.she
reports to have positive fetal movements.

she booked at 15 weeks attended 5times received all suppliments as required.she is PMTCT-2,VDRL-
nr ,BG-B positive.she was normotensive and non protenuric during anc visits.

o/e-alert, not dyspneic,mild pale, not cyanotic, afebrile, bilateral pitting LL oedema
vitals;bp-172/111mmhg pr-88bpm t-36.4c

p/a-cephalic presentation with longitudinal lie with fhr-145bpm

cvs,cns,r/s-intact
done;fbp-normal wbc,hb-11g/dl plt-135 urinalysis-pH 8.0SG 1.020,Pro ++,Ket ++, Sed - Nil b/s-nmps
obs uss-Gestation age= 36 weeks, 06days.AFI-14.3 cm
EDD= 30/07/2019
EFBWT=3077g
FHR= 150bpm

wdx;pre eclampsia

plan
monitor bp hrly
monitor fhr
alt and ast
bun and creatinine

PROGRESS IN PRE ECLAMPSIA

seen patient during ward round with obsgy team

known patient with pre eclampsia for the previous pregnancies
G4P3L3 GA-37 weeks by date

wdx;pre eclampsia

today;complaints of headache
o/e-alert, not dyspneic,mild pale, not cyanotic, afebrile, bilateral pitting LL oedema
vitals;bp-144/102mmhg pr-64bpm rr-20cpm t-36c

progress;over the night dbp-(76-115)mmhg and sbp-(135-183)mmhg

obs uss-Gestation age= 36 weeks, 06days.AFI-14.3 cm
EDD= 30/07/2019
EFBWT=3077g

plan
monitor bp 2hrly
monitor fhr 4hrly
for possible induction at 4:00am with misoprostol 25mcg

ELECTIVE C/S (PREVIOUS SCAR)

CASE 1

Seen the patient in labour ward

G3P2L2 (Delivered by C/S)
GA of 37weeks + 5 days by date
EDD- 16/09/2019

Patient came for follow up at clinic. Had no labour pain. No pv discharge.

She report to appreciate fetal movements.

ANC
Booked at 12 weeks made 6 normotensive non proteinuric visits, PMTCT 2, VDRL nr, Blood group O
positive. Hb ranging from 8.9g/dl to 10.8g/dl. She received all supplements as per EPI.

O/E
Alert, afebrile, not pale, not jaundiced, not cyanosed, had bilateral ankle pitting edema.

Vital Signs-were within normal range

P/A

FH- 38cm
FHR-140bpm
No contractions

Pdx;
-Term pregnancy not in labour

Investigations done
Obstatric USS-Impression: Single viable intrauterine pregnancy at 38w+4d

Given
IV Ceftriaxone 2g stat
IV Metronidazole 500mg stat

PLAN
For elective C/S due to 2 previous scar
EMERGENCY C/S
Seen the pt in the maternity ward

Primigravid

GA of 40 weeks + 2 days by date

LNMP-14/10/2018

EDD- 21/7/2019

m.c

She reported per vaginal spotting. She also reports to appreciate fetal movements.

ANC

Booked at 17 weeks made 5 normotensive non proteinuric visits, PMTCT 2, VDRL nr, Blood group O
positive. Hb ras ranging from 10.5g/dl to 13.3g/dl. She got all supplements.

O/E

Alert, afebrile, not pale, not jaundiced, not cyanosed, no ll edema.

Vital Signs- were within normal range

P/A

Longitudinal lie, cephalic presentation

FH-38cm

FHR-142bpm

No contractions

Level 5/5

Obstetric USS- EFW - 2990grms , FHR - 130Bpm, Average G- 35w+6d , EDD by u/s 24.08.2019

No gross fetal abnormality is seen

Cervix is long and closed

Impression:

 Single viable intrauterine pregnancy at 35w+6d

Pdx; Post date Term Pregnancy

PLAN

For emergency C/S due to NRFS and IUGR

AT 4:50 PM

PV exam; soft and slightly thick cervix dilated at 6cm, intact membrane

fhr-142bpm

Plan

monitor progress of labor and fhr

NEW ADMISSION LABOUR

CASE 1

Seen the pt in the labour ward

G2 P1 L1

LNMP:30/7/19 EDD:06/05/20 GA:39W6D

Brief hx

Presented with LAP for 1 day prior to admission, it was intermittent increasing with time and
radiating to the back, a/w pv discharge of blood mixed with mucus, no passage of gush of water,
she reported of experiencing fetal movements.

ANC

Booked at 21 weeks, made 5 normotensive non proteinuric visits, PMTCT 2, VDRL NR, Blood
group O positive, got all supplements.

OBS HX

1st pregnancy in 2015, a female baby delivered by SVD weight 2.5 kg, no complication
experienced during labour or delivery.

O/E

Alert, afebrile, not pale

Vital Signs

were within normal range

P/A

Longitudinal lie, cephalic presentation.FH-38 cm,level 4/5,FHR-140bpm

PVE at 09;30 AM

Cx was 4 cm dilated,soft and and slighlty thick, blood show and membrane are intact

Pdx

Term Pregnancy in active phase of labor.

Plan

Monitor progress of labour accordingly

CASE 2

Seen the pt in the labour ward

G3P2L2
GA of 41 weeks and 4 days by date

EDD- 17 Aug 2019

m.c

the patient came with the main complaint of lower abdominal pain for 1 day, which radiated to the
back. However she reported no pv discharge but had appreciated fetal movements.

ANC

Booked at 21 weeks made 4 normotensive non proteinuric visits, PMTCT 2, VDRL nr, Blood group
O positive. Hb was ranging from 10.6g/dl to 13.6g/dl. She received all supplements as per EPI.

O/E

Alert, afebrile, not pale, not jaundiced, not cyanosed, no ll edema.

Vital Signs- were within normal range

P/A

Longitudinal lie, cephalic presentation

FH-37cm

FHR-142bpm

Mild contractions

Level 3/5

PVE at 2230hrs

Cx was 6cm dilated, it was soft and slightly thick,Intact Membranes

Pdx;Term Pregnancy in active phase of labor

PLAN

Monitor the progress of labour and monitor the vitals

CASE 3

Seen the pt in the labour ward

G4P1+2L1 (delivered by c/s)

GA of 39 weeks +1 day by date

LNMP-11/11/2018

EDD-18/08/2019

m.c

LAP for 1 day which was gradual on onset, radiating to back and thighs. No hx of pv discharge. She
reported to appreciate fetal movements

ANC

Booked at 13 weeks made 6 normotensive non proteinuric visits, PMTCT 2, VDRL nr, Blood group O
positive.. She got all supplements.

O/E

Alert, afebrile, not pale, not jaundiced, not cyanosed, no ll edema.

Vital Signs- were within normal range

P/A

Longitudinal lie, cephalic presentation

FH- 37cm

FHR-148bpm

Mild contractions

Level 4/5

PVE at 0420hrs

Cx - 3cm dilated, soft and thick, membranes were intact

Pdx; Term Pregnancy in latent phase of labor

PLAN

To transfer the patient to Lugalo Military Hospital since she was counseled for emergency c/s due to
previous scar in labour but the patient refused and opted for normal delivery by svd.

PROGRESS AFTER C/S

Seen the pt P1L1 1st day post c/s 2\' Cervical dystocia
Outcome; Female baby 3.1kg scored 8&10 per APGAR with no complications during delivery

Today; No new complaints

O/E; Stable

PLAN
To give Oral medications

NEW ADMISSION IN PREGNANCY

Seen the patient on admission

G2P1L1 by C/S
GA of 35 weeks and 5 days by date
LNMP- 6th December 2018
EDD- 11th September 2019

She reported to have severe LAP radiating to the back and thigh for 1 day. There was no PV discharge
and she reposted of appreciated fetal movements. However she was scheduled for elective c-section on
29th august 2019.

ANC: she booked at 21 weeks of GA, had a total of 4 normotensive and non-proteinuric visists. The last
Hb was 12.4g/dl. She is PMTCT 2 and VDRL was NR, Blood group O+

O/E: she was alert, afebrile, not pale, not jaundiced, no ll edema
Vitals : stable
P/A: Gravid abdomen, cephalic presentation, FH- 30cm
Other systems were normal

PDX:
- UTI IN PREGNANCY
- PRETERM PREGNANCY IN LABOUR

Investigations done
- Malaria ( B/S )- NPS
- Urinalysis- NAD
- Hb- 11.3g/dl
- Uss obs – EFW-2718grms , FHR- 137Bpm, Average GA- 35w+3d, EDD by u/s 8.09.2019, No gross fetal
abnormality is seen.

WDX:
- PRETERM PREGNANCY IN LABOUR

PLAN:
- IV Hyoscine 20mg tds
- IV Hydrocortisone 1g stat
- IV ringers lactate 1l
- To be reviewed during the ward rounds

PROGRESS IN LABOUR SVD

AT 03:30AM

PV exam; soft and slightly thick cervix dilated at 3cm, intact membrane

fhr-142bpm

Plan
monitor progress of labor and fhr
To induce labour with misoprostol 25mcg

Next PV exam at 9am

POST DELIVERY SVD

seen patient on admission
BVC plan
encourage breastfeeding
tabs amoxyclav 625mg bd for 7 days
tabs aceclofenac 100mg bd for 5 days

tabs tinidazole 500mg bd 5/7

counseled on sitz bath

NEW ADMISSION IN LABOUR TWIN PREGNANCY

Case 1

Seen the patient in labour ward

Primegravid with twin pregnancy
GA of 32 weeks by USS

EDD- 13 August 2019 by USS

m.c
LAP 1 day which was gradual on onset and radiating to the back and thigh a/w mucus like pv discharge
however no foul smelling pv discharge, no pv bleeding, no fever.
She report to appreciate fetal movements.

ANC
Booked at 15 weeks made 5 normotensive non proteinuric visits, PMTCT 2, VDRL nr, Blood group A
positive. Hb ranging from 12.0g/dl to 12.7g/dl. She received all supplements as per EPI.

O/E
Alert but in labour pain, afebrile, not pale, not jaundiced, not cyanosed, no ll edema.

Vital Signs-were within normal range

P/A
Both twins have Longitudinal lie, cephalic presentation
FH-39cm
1st twin-FHR-138bpm, 2nd twin-FHR-142bpm
Mild contractions

PVE at 4am
Cx-4cm dilated, soft and thin, with clear liquor and bloody show

Pdx;

Preterm Premature Rupture of membranes

-Preterm twins pregnancy in active phase of labour

Investigations done

Obstetric ultrasound- Impression:

 Di amniotic and Di chorionic twin pregnancy

 Mild oligohydramnios

Given

Im dexamethasone 12mg stat

IV Ringers lactate 1L

PLAN

Monitor the progress of labor.

Next pv exam at 8am

Case 2

CASE 3

Seen the pt in the labour ward

G2P1L1
GA of 40weeks+1day by date
LNMP-07/08/2018

m.c
LAP for 1 day which was gradual on onset, radiating to back and thighs. No hx of pv discharge. She
reported to appreciate fetal movements
ANC
Booked at 11 weeks made 7 normotensive non proteinuric visits, PMTCT 2, VDRL nr, Blood group B
positive.. She got all supplements.

O/E
Alert, afebrile, not pale, not jaundiced, not cyanosed, no ll edema.

Vital Signs- were within normal range

P/A
Longitudinal lie, cephalic presentation
FH-38cm
FHR-142bpm
Mild contractions
Level 3/5

PLAN
To monitor the vitals
To monitor the progress of labour
Monitor the fhr
To give oxytocin 2.5I.U in 500mls of RL

NEW ADMISSION IN MATERNITY

MALARIA IN PREGNANCY

CASE 1

Seen the patient on admission

G3P2L2 with 2 previous scars
GA- 28weeks
LNMP- 10th December 2018
EDD- 16th September 2019

The patient has a main complain of fever for 2 weeks which was on an off. It was of gradual onset
associated with mild headache, no loss of consciousness, no convulsions, no blurry vision, no vomiting or
diarrhea, no abdominal pain or PV discharge. The patient also presented with cough which was non-
productive for 1 week.
She reported to be treated with UTI 1 week ago of which she was on IV medications for 5 days without
any improvements. She also reports of appreciated fetal movements.

ANC:
She had a total of 4 normotensive and non- proteinuric visits. She received all suppliments as per EPI.
VDRL- NR. PMTCT- 2. Blood group O+. the Hb has been ranging from 10.8 to 8g/dl.

O/E:Obese, Febrile, clinically pale, not jaundiced, not cyanosed, no ll edema

Vitals: BP- 128/60mmHg, PR- 127b/min, T- 38.6C, RR- 20 cpm

CNS & RS: NAD

P/A: Gravid abdomen, with cephalic presentation, FH- 24cm
Other systemic exam: NAD

PDX:
- MALARIA IN PREGNANCY DDX UTI, TYPHOID
Investigations done:
- MRDT- +
- Malaria ( b/s )- 68mps
- Urinalysis - pH 6.0, SG 1.025,Ket +++, Bld +, Sed - Rbc\'s 10-13/HPF
- FBP- neu- 81.8%, Hb- 10.3g/dl
- Widal test – NAD

WDX:
- MALARIA IN PREGNANCY
- UTI IN PREGNANCY

PLAN:
- IV artesunate 300mg at 0, 12 and 24hrs
- IV ceftriaxone 2g stat
- IV metronidazole 500mg tds
- IV dexamethasone 12mg od for 2 days
- IV paracetamol 1g tds
- Cough syrup tds for 5 days

CASE 2

Seen the pt on admission

G2P1L1

GA of 7 weeks + 4 days by date

EDD- 1/03/2020

m.c-epigastric pain X1/52

lower abdominal painX1/52

Vomiting for 1/7

The patient presented with a hx of abdominal pain was gradual on onset which was more on the epigastic
and lower abdomen radiating to the back a/w pv bleeding which was small in amount. No hx of peptic
ulcer disease. Also reported to have diarrhea 4 times and vomiting 5-6 times containing bilious food
materials small in amount. Patient also reported to have dizziness, no fever or loss of consciousness.

ROS

CNS-NAD

RS- NAD

O/E-Alert, afebrile, not pale, not jaundiced, not cyanosed, no ll edema.

Vital Signs

BP-111/69mmHg

PR-86bpm

RR-18cpm

T-36.5C

Pdx; preterm Pregnancy at 7 weeks

Peptic ulcer disease

Malaria r/o UTI

Investigation done

B/S for malaria

FBP

Treatment given

H.Pylori antigen

Urinalysis

IV Ondansetron 8mg tds

IV Hyoscine butylbromide 20 mg tds

IV RL-1L

IV Pantoprazole 40mg Bd

PLAN

To monitor vitals

CASE 3

Seen the patient on admission

G all by SVD at a GA of 35 weeks by date
LNMP- 5th November 2018
EDD- 12th August 2019

The patient presented with headache for 3 days which was of gradual onset associated with awareness of
heartbeats and vomiting for 2 days, it was non- projectile and contained recently eaten food materials.
She could vomit twice per day. There was no LOC, no blurry vision, no convulsions, no diarrhea. She also
reported to have severe LAP radiating to the back and thigh for 1 day. There was no PV discharge and
she reposted of appreciated fetal movements.

ANC: she booked at 16 weeks of GA, had a total of 4 normotensive and non-proteinuric visists. The last
Hb was 11. 9g/dl. She is PMTCT 2 and VDRL was NR, Blood group A+

O/E: she was alert, afebrile, not pale, not jaundiced, no ll edema
Vitals : stable
P/A: Gravid abdomen, cephalic presentation, FH- 33cm
Other systems were normal

PDX:
- MALARIA IN PREGNANCY DDX UTI
- ANEMIA IN PREGNANCY
- PRETERM PREGNANCY IN LABOUR

Investigations done
- Malaria ( B/S )- NPS
- Urinalysis- NAD
- Hb- 11.5g/dl
- Uss obs – EFW-2337grms , FHR- 141Bpm, Average GA- 33w+3d, EDD by u/s 24.08.2019, No gross
fetal abnormality is seen , Cervix is long and closed

PDX:
- PRETERM PREGNANCY IN LABOUR

PLAN:
- IV Hyoscine 20mg tds
- IV Hydrocortisone 1g stat
- IV ringers lactate 1l
- To do the next pv at 2100hrs

PROM IN TERM PREGNANCY

Case 1
Seen the pt in the labour ward
Primigravid
GA of 37 weeks + 4 Day by date
LNMP- 28/10/2018
EDD- 5/8/2019

m.c
She reported that she had gush of water discharge per vaginal flowing down towards the thighs. However
it was non- foul smelling not blood stained. She also reports to appreciate fetal movements.

ANC
Booked at 18 weeks made 4 normotensive non proteinuric visits, PMTCT 2, VDRL nr, Blood group A
positive. She got all supplements. Hb was ranging from 9.1g/dl to 10.4g/dl.

O/E
Alert, afebrile, not pale, not jaundiced, not cyanosed, no ll edema.

Vital Signs- were within normal range

P/A
Longitudinal lie, cephalic presentation
FH-32cm
FHR-140bpm
No contractions
Level 5/5

PVE at 1800hrs
Cx- 3cm dilated, thick, with ruptured membranes, had clear liquor.
Pdx; Term Pregnancy with PROM

PLAN
To monitor the progress of labour
To give misoprostol 50mcg
To monitor the vitals

C0ase 2

Seen the pt in the labour ward

Primigravid

GA of 40 weeks + 1 Day by date

LNMP- 02/11/2018

EDD- 8/8/2019

m.c
She reported that she had gush of water discharge per vaginal flowing down towards the thighs. However
it was non- foul smelling not blood stained. She also reports to appreciate fetal movements.

ANC

Booked at 14 weeks made 5 normotensive non proteinuric visits, PMTCT 2, VDRL nr, Blood group O
positive. She got all supplements.

O/E

Alert, afebrile, not pale, not jaundiced, not cyanosed, no ll edema.

Vital Signs- were within normal range

P/A

Longitudinal lie, cephalic presentation

FH-32cm

FHR-140bpm

No contractions

Level 5/5

PVE at 1740hrs

Cx- 3cm dilated, thick, with ruptured membranes, had clear liquor.

Pdx; Term Pregnancy with PROM

PLAN

To monitor the progress of labour

To give misoprostol 50mcg

To monitor the vitals

PRETERM PROM IN PREG

Case 1

Seen the pt in the labour ward

Primigravid

GA of 31 weeks

m.c

the patient came with the main complaint of lower abdominal pain for 1 day, which radiated to the back.
How ever she reposted of no pv discharge but had appreciated fetal movements.

The mother has history of being treated at 1 day ago at rmh diagnosed to have UTI and was given iv
antibiotic stat and oral antibiotics

ANC-mother did not come with rch card. Mother has never attended clinic at RMH.

O/E

Alert, afebrile, not pale, not jaundiced, not cyanosed, no ll edema.

Vital Signs- were within normal range

P/A

Longitudinal lie, cephalic presentation

FH-30cm

FHR-146bpm

Moderate contractions

Level 3/5

PVE at 1018hrs

Cx was 8cm-9cm dilated, soft and thin,membrane was artificially ruptured and thick meconium was seen

Pdx; Pre-Term Pregnancy in active phase of labor.

PLAN

To monitor progress of labour

To monitor fetal heart rates

POST OP NOTES

HYDROTUBATION
SURGEON: Dr. Kashagama
Under general anesthesia, patient was kept in lithotomy position. She was cleaned and draped
aseptically. Using sims vaginal speculum and tenaculum forceps, cervix was identified. No lesion seen on
the cervix, cervix was 1 cm dilated.

Done- Hydrotubation was done using a 20cc syringe, mixture of Normal saline and Hydrocortisone 200mg
was flushed through the cervix. Patent sound was heard bilaterally through the tubes.

EVACUATION

Op notes
Patient was kept in lithotomy position

the patient was cleaned and draped aseptically, Using sims's vaginal speculum and teneculum, the
cervical os was identified

Done- Evacuation of retained products of conception

Post op orders-

IV ceftriaxone 1gm stat

IV metronidazole 500mg tds

IM Diclofenac 75mg tds, IM tramadol 100mg tds

IV RL 1l

EUA and Wedge Biopsy Cervix

Cervical biopsy was taken by dr.kash, under spine anesthesia patient was positioned in
lithotomy was aseptically cleaned and draped, on examination cervix was protruded
with mass and posterior located cervical os, with normal vaginal wall, then wedge
biopsy was taken, then cervical os was located in normal anatomical position,
homeostasis was archived by stitching\nplan\ntabs metronidazole 500mg tds 5/7\ncaps
amoclav 625mg bd 5/7\nim diclofenac 75mg tds 1/7\ncatheter insitu per cervical os

C/S NOTES
SURGEON: Dr. Majinge
INDICATION: cervical dystocia clear liquor
Under spinal anesthesia she was cleaned and draped aseptically. Abdomen opened through pfannestiel
FINDINGS: Gravid uterus ,Normal bladder, ovaries and tubes bilaterally, well formed lower segment baby
was in cephalic with clear liquor.
DONE:low segment uterine incision was done,extraction of a male baby 2.1 kg done scored 9-10 on
APGAR.Third stage completed, uterus mopped and repaired in layers.Abdomen repaired in layers after
correct swabs and instrument count.
Plan:
iv ceftriaxone 1gm od
iv metronidazole 500mg tds
inj tramadol 100mg tds
inj diclofenac 75mg tds

Iv DNS/ RL 3L /24hrs
oral sips and ambulation after 8hrs
Monitor vitals, Input and outputs

C/S PROCEDURE IN PATIENT WITH TWIN PREGNANCY

SURGEON: Dr. Kashagama

INDICATION: Twin pregnancy with malpresentation

Under spinal anesthesia and in supine position she was cleaned and draped aseptically. Abdomen
opened through pfannestiel incision

FINDINGS: Gravid uterus with Normal bladder, ovaries, fallopian tubes bilaterally, well formed lower
segment, 1st twin was in breech presentation as well as the 2nd twin.

DONE:Lower segment transverse uterine incision, extraction of 1st twin a male baby3.1 kg and scored 9
then 10 APGAR and the 2nd twin was extracted a male baby 2.5kg scored 8 and 10 APGAR, they were
diamniotic, monochorionic . Third stage completed, uterus mopped and repaired in layers. Abdomen
repaired in layers after correct swabs and instrument count.Vaginal toilet done. EBL 400mls
Plan:Medicines as per treatment chart\nMonitor vitals, Input and outputs
Seen the patient on admission

G10P0+9L0

GA- 4 weeks

LNMP- 1 month ago

M/C- PV bleeding 2/7

The patient reported to have pv bleeding for 2/7 associated with mild lower abdominal pain.

No hx of fever, diarrhea. She reported to still experience heavy bleeding after being kept on misoprostol 1
day ago at clinic visit.

ROS-were normal

Past obstetric hx

She has hx of 9 previous pregnancy losses

1st was at 8months she had abruption placenta then deliver

2nd was at 6 months, 3rd was at 5 months, the subseguent were all at 1 month.

She reported to be blood group O-ve whilst her husband is O+ve

O/E: she was alert, afebrile, not pale, not jaundiced, no ll edema
Vitals : stable

Systemic examination- NAD

Investigations done

Hb

Blood grouping and cross matching

Obs USS- done on 30/08/2019 at RMH as outpatient

Impression of missed abortion

Pdx- Missed abortion

Plan

Planned for evacuation today

Seen the pt in the labour ward

G5P4L4 (All by svd)

GA of 42 weeks and 4 days by date

EDD- 28 Aug 2019

Is a known patient with chronic hypertension on regular medication (Methyldopa)

m.c

the patient came with the main complaint of lower abdominal pain for 1 day, which radiated to the back.
However she reported no pv discharge but had appreciated fetal movements.

ANC

Booked at 19 weeks made 6 non proteinuric, hypertensive on 2 visits visits, PMTCT 2, VDRL nr, Blood
group A positive. Hb was ranging from 10.6g/dl to 13.6g/dl. She received all supplements as per EPI.

O/E

Alert, afebrile, not pale, not jaundiced, not cyanosed, no ll edema.

Vital Signs- were within normal range

P/A

Longitudinal lie, cephalic presentation

FH-38cm

FHR-140bpm

Mild contractions

Level 3/5

PVE at 0200hrs
Cx was 4cm dilated, it was soft and slightly thick,Intact Membranes

Pdx;Term Pregnancy in active phase of labor

PLAN

Monitor the progress of labour and monitor the vitals

g4p3l3 ga 37+ pmtct 1/dm labour pains k=headache no epigastric pain o/e bp 160/89 bp 182/97 p/e fh
36/40 fhr 134 pve dx pmtct 1/dm/polyhydramnious, 1ps, admit councel about danger signs

Seen the pt in the labour ward

G4P3L3

GA of 34 weeks + 5 days by date (1 previous scar)

EDD- 24 Oct 2019

Known patient with diabetes and hypertension on regular antihypertensives

m.c

The patient came with the main complaint of lower abdominal pain for 1 day, which radiated to the
back. However she reported no pv discharge but had appreciated fetal movements.

ANC

Booked at 16 weeks made 5 normotensive non proteinuric visits, PMTCT 1, VDRL nr, Blood group
B positive. Hb was ranging from 7.4 g/dl to 10.4g/dl. She received all supplements as per EPI.

O/E

Alert, afebrile, not pale, not jaundiced, not cyanosed, no ll edema.

Vital Signs- BP-144/100mmhg, pr-107bpm, T-37.4C RR-20cpm

P/A

Longitudinal lie, cephalic presentation

FH-37cm

FHR-140bpm

Mild contractions

Level 5/5

PVE at 1500hrs

Cx was 2cm dilated, it was soft and thick, Intact Membranes

Pdx; Term Pregnancy in latent phase of labor

PLAN

Monitor the progress of labour and monitor the vitals

Seen the pt in the labour ward

Primigravid

GA of 40 weeks and 5 days by date

EDD- 15 Sept 2019

m.c

the patient came with the main complaint of lower abdominal pain for 1 day, which radiated to the
back. However she reported no pv discharge but had appreciated fetal movements.
ANC

Booked at 18 weeks made 5 normotensive non proteinuric visits, PMTCT 2, VDRL nr, Blood group O
positive. Hb was ranging from 10.3g/dl to 13.4g/dl. She received all supplements as per EPI.

O/E

Alert, afebrile, not pale, not jaundiced, not cyanosed, no ll edema.

Vital Signs- were within normal range

P/A

Longitudinal lie, cephalic presentation

FH-38cm

FHR-142bpm

Mild contractions

Level 5/5

PVE at 1130hrs

Cx was 2cm dilated, it was soft and thick,Intact Membranes

Pdx;Term Pregnancy in latent phase of labor

PLAN

Monitor the progress of labour and monitor the vitals

Encourage ambulation

For possible induction tommorow at 4am

Seen the patient in the ward

Nulliparous

c/c-pain and swelling on the left labia 5/7

She presented with swelling and pain on the left labia which was gradual in onset progressively
increasing with time. It was associated with low grade fever and headaqche. No hx of PV bleeding or low
abdominal pain.

ROS- NAD

Past gyne hx

Started menarche at 11 years, has 3 day flow with partially soaked uses 5-6 pads per day.

Local examination

Has swelling on left labial region, pus discharging wound , tenderness on touch

Systemic examination

NAD

Pdx- Bartholin cyst

Investigations done

FBP

Blood grouping

Treatment given

Tabs Norfloxacin + Tinidazole 1 tab BD for 10/7

Tabs Doxycycline 100mg BD 10/7

Tabs Meloxicam 7.5mg BD

Plan
For Marsupilization today

Preop medication- IV Ceftriaxone 1 gm stat

IV Metronidazole 500mg stat

POST DELIVERY

at 0848 hours \nmother delivery a female baby 2.5 kg ,scored 9 and 10 in 1st min and 5th min
respectively ,RBG 3.9 mmol/l third stage complete ,she had first degree tear and repaired successfully ,
Baby received inj vita K 0.5ml and tetracycline eye ointment \nplan \nTo give baby nevirapine
prophylaxis \nTo encourage mother exclusive breast feeding \ntransfer to maternity ward

Tab amoxiclav 625mg bd 5/7

Tab tinidazole 500mg bd 5/7

Tab paretamol 1g tds 5/7

PV EXAMINATION LABOUR

PVE at 0830hours
Cx was 5cm dilated, soft , thin , Membranes were intact

level 3/5
moderate contraction
FHR 144b/m

plan
augmentation of labour with oxytocin 5IU in 500ml of RL
Monitor progress of labour
SVD expected

seen patient

40years

nulliparous

known patient with recurrent multiple uterine myoma had myomectomy last year
presented with progressive pv bleeding for about I year folllowing myomectomy. I day prior to
admission pt presented with severe pv bleeding clotting in nature and she used to change 6 pads per
day full soaked with blood a/w LAP GBW, easy fatigability. denied hx of headache, fever, blurred vision,
Difficulty in breathing on lying flat. Denied hx vomiting, passing loose stool or change in micturation
habit.

In course of her illness pt attended clinic at our facilities for abt 1 year and used tranexemic acid and
duphastrone with improvement until one day prior to admission.

ON

g/e

alert,afebrile, not pale,