Dr.

Nerve DYNAMIC DIAGNOSERS

 PREFACE
Greetings from Dr.Nerve……..!!!
This is Dynamic Diagnosers from Dr.Nerve.
We have launched this team to acknowledge you
about case presentation which includes history
taking and examination. The viewpoint of this
project is to make it useful for your clinical
studies as reference. The following are the
departments covered by us,
❖ ENT
❖ ORTHOPAEDICS
❖ PEDIATRICS
❖ COMMUNITY MEDICINE
❖ OBSTETRICS AND GYNAECOLOGY
❖ GENERAL MEDICINE
❖ GENERAL SURGERY
The case Performa for OBSTETRICS AND GYNAECOLOGY
has been uploaded here. Kindly make use of it…….

Dr.Nerve DYNAMIC DIAGNOSERS

CASES COVERED IN THIS MODULE………

❖ ANEMIA

❖ GESTATIONAL DIABETES MELLITUS

❖ GESTATIONAL HYPERTENSION

❖ NORMAL PREGNANCY

❖ Rh NEGATIVE PREGNANCY

Dr.Nerve DYNAMIC DIAGNOSERS

 ANEMIA
Name
Husband’s name
Age
Occupation
Education
Address
Socioeconomic status
Obstetric code
LMP
EDD
Whether booked and immunised or not
CHIEF COMPLAINT
➢ Patient came to OPD with H/O amenorrhea for _____
months and has referred from _____ as a case of
anemia.
HISTORY OF PRESENT ILLNESS
➢ H/O lethargy and fatiguability
➢ H/O swelling of legs, arms, abdominal wall
➢ H/O breathlessness, palpitation, chest pain
➢ H/O bleeding PV

MENSTRUAL HISTORY

Dr.Nerve DYNAMIC DIAGNOSERS

 ➢ Attainment of menarche at _____
➢ Regular cycle or irregular cycle
➢ Associated with pain or clots or not
MARITAL HISTORY
➢ Married at ____ years of age
➢ H/O taking contraceptives
➢ Degree of consanguinity
OBSTETRIC HISTORY OF PREVIOUS PREGNANCY
➢ Conceived at ___ years of age
➢ Male/female baby
➢ Baby birth weight
➢ Baby cried immediately or not after birth
➢ Breast feeding for ______
PRESENT PREGNANCY
➢ Booked and immunised / not
➢ Conceived after ____ yrs of previous pregnancy
➢ Td vaccination
➢ Antenatal visits
1ST TRIMESTER
➢ Pregnancy was confirmed by
➢ H/O nausea and vomiting
➢ H/O fever with rashes
➢ H/O radiation exposure
➢ H/O drug intake
➢ H/O spotting
➢ H/O bleeding PV

Dr.Nerve DYNAMIC DIAGNOSERS

 ➢ USG done at 3rd month or not
2ND TRIMESTER
➢ Quickening felt at 5th month or not
➢ USG done at 5th month or not
➢ H/O blurring of vision
➢ H/O headache, abdominal pain, leg swelling
➢ IFA tablets taken or not
3RD TRIMESTER
➢ Able to perceive foetal movements
➢ Bleeding or draining PV
➢ H/O fatiguability and lethargy
PAST HISTORY
➢ H/O DM, TB, asthma, thyroid disease, IHD, HT
➢ H/O hematemesis, epistaxis, bleeding, piles, dysentery
➢ H/O bleeding tendency, prolonged bleeding
➢ H/O worm infestation, walling barefoot
➢ H/O UTI
➢ H/O malaria
➢ Previous surgery
➢ H/O blood transfusion
FAMILY HISTORY
➢ H/O DM, HT, preeclampsia, twin pregnancy in family
PERSONAL HISTORY
➢ Mixed diet
➢ Normal bowel and bladder habits
➢ No adverse social habits
Dr.Nerve DYNAMIC DIAGNOSERS
GENERAL EXAMINATION
➢ Conscious, oriented to time place and person
➢ Built and nourishment
➢ Pallor
➢ Icterus
➢ Clubbing
➢ Cyanosis
➢ Pedal oedema
➢ Lymphadenopathy
➢ CVS – S1 AND S2 sound heard or not and any murmur
➢ RS – NVBS heard or not, any added sounds
➢ Breast and thyroid
VITALS
➢ Pulse
➢ BP
➢ Respiratory rate
➢ Temperature
➢ Weight Gain in pregnancy
SYSTEMIC EXAMINATION
INSPECTION
➢ Uterus- enlargement
➢ Linea nigra, stria gravidarum
➢ Movements of all quadrants with respiration
PALPATION
➢ Fundal height
➢ Symphysiofundal height

Dr.Nerve DYNAMIC DIAGNOSERS

 ➢ Abdominal girth
➢ Fundal grip
➢ Umbilical grip
ASCULTATION - FHS
DIAGNOSIS

CASE SHEET OF ANEMIA CASE

Name – Mrs. Leena
Husband’s name – Mr. Ajay
Age - 25
Occupation - housewife
Education – 8th standard
Address - karur
Socioeconomic status – lower middle class
Obstetric code – G2P1L1
LMP – 12/10/20
EDD – 19/7/21
Booked and immunised
CHIEF COMPLAINT
➢ Patient came to OPD with H/O amenorrhea for 8
months and has referred from karur GMC as a case of
anemia.
HISTORY OF PRESENT ILLNESS
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ H/O lethargy and fatiguability for past 1 week
➢ No H/O swelling of legs, arms, abdominal wall
➢ No H/O breathlessness, palpitation, chest pain
➢ No H/O bleeding PV
➢ Diagnosed as anemia during routine examination

MENSTRUAL HISTORY
➢ Attainment of menarche at 13 years
➢ Regular cycle 5/30 day cycle, normal flow
➢ Associated with pain or clots
MARITAL HISTORY
➢ Married at 20 years of age
➢ No H/O taking contraceptives
➢ No consanguinity
OBSTETRIC HISTORY OF PREVIOUS PREGNANCY
➢ Conceived at 22 years of age
➢ All trimester was uneventful
➢ Male baby
➢ Baby birth weight – 2 kg via normal vaginal delivery at
government hospital.
➢ Baby cried immediately
➢ Exclusive Breast feeding for 6 months
PRESENT PREGNANCY
➢ Booked and immunised at karur GMC
➢ Conceived after 2 yrs of previous pregnancy
➢ Td vaccination – 2doses given at 3 and 5 months
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ Antenatal visits – 6 completed
1ST TRIMESTER
➢ Pregnancy was confirmed by UPT at 40 days in GMC
➢ H/O nausea and vomiting
➢ No H/O fever with rashes
➢ No H/O radiation exposure
➢ No H/O drug intake
➢ No H/O spotting
➢ No H/O bleeding PV
➢ USG done at 3rd month
2ND TRIMESTER
➢ Quickening felt at 5th month
➢ USG done at 5th month
➢ No H/O blurring of vision
➢ No H/O headache, abdominal pain, leg swelling
➢ IFA tablets taken regularly
3RD TRIMESTER
➢ Able to perceive foetal movements
➢ No Bleeding or draining PV
➢ H/O fatiguability and lethargy
➢ Diagnosed as anemia and given Inj. Iron Sucrose
PAST HISTORY
➢ No H/O DM, TB, asthma, thyroid disease, IHD, HT
➢ No H/O hematemesis, epistaxis, bleeding, piles,
dysentery
➢ No H/O bleeding tendency, prolonged bleeding

Dr.Nerve DYNAMIC DIAGNOSERS

 ➢ No H/O worm infestation, walling barefoot
➢ No H/O UTI
➢ No H/O malaria
➢ No Previous surgery
➢ No H/O blood transfusion
FAMILY HISTORY
➢ No H/O DM, HT, preeclampsia, twin pregnancy in family
PERSONAL HISTORY
➢ Mixed diet
➢ Normal bowel and bladder habits
➢ No adverse social habits
GENERAL EXAMINATION
➢ Conscious, oriented to time place and person
➢ Moderately Built and nourished
➢ No Pallor, icterus, clubbing, cyanosis
➢ No Pedal oedema
➢ No Lymphadenopathy
➢ CVS – S1 AND S2 sound heard and no murmur
➢ RS – NVBS heard , no added sounds
➢ Breast and thyroid = normal
VITALS
➢ Pulse – 86/min
➢ BP – 120/80 mm of Hg
➢ Respiratory rate – 13/min
➢ Temperature - Afebrile
➢ Weight Gain in pregnancy – 11 kgs

Dr.Nerve DYNAMIC DIAGNOSERS

SYSTEMIC EXAMINATION
INSPECTION
➢ Uterus- enlarged longitudinally
➢ Linea nigra, stria gravidarum seen
➢ All quadrants moves with respiration
PALPATION
➢ Fundal height corresponds to 32 weeks of gestation
➢ Symphysiofundal height – 32 cm
➢ Abdominal girth – 103 cm
➢ Fundal grip – broad, soft, independently ballotable
podalic pole felt
➢ Umbilical grip – right side – multiple small nodules,
probably limb nodes
Left side – smooth curved resistant back, probably spine.
1st pelvic grip – Hard round independently ballotable head
is occupying the lower pole of uterus.
ASCULTATION – FHS heard on left spine umbilical line
DIAGNOSIS
25 years old Mrs. Leena G2P1L1 completed 32 weeks of
gestation with LMP 12/10/20 and EDD – 19/7/21. Who on
examination presents with single live foetus in cephalic
presentation with good FHS. She is a case of anemia
complication pregnancy who has been admitted for
evaluation and management of anemia

Dr.Nerve DYNAMIC DIAGNOSERS

 GESTATIONAL DIABETES MELLITUS
Name
Age
Occupation
Socioeconomic status
Address
Booked and immunized at --------- PHC
Obstetric score
Last Menstrual Period
Expected Delivery Date

CHIEF COMPLAINTS
Abdominal pain for _________ days
HISTORY OF PRESENTING ILLNESS
➢ Pain
o Onset
o Duration
o Course
o Radiating or not
o Aggravating factor
o Relieving factor
o H/O fever with chills and rigor / burning
micturition
o H/O vaginal discharge-
colour,consistency,quantity,odour,blood stained
or not ,itching present or not
o H /O excessive weight gain or excessive
enlargement of the uterus
o H/O reduced urinary output
o H/O polyphagia
Dr.Nerve DYNAMIC DIAGNOSERS
 o H/O morning sickness
o H/O treatment with insulin,

MENSTRUAL HISTORY
MARITAL HISTORY
Obstetric history
FIRST PREGNANCY :
➢ Conceived within ____ year of marriage, spontaneous
or not , contraceptives used or not
➢ Pregnancy confirmed by ______ at ______ P.H.C.

➢ Mode of delivery:
➢ Indication :
➢ postpartum IUCD done or not
➢ Gender of the baby
➢ birth weight :
➢ cried immediately after birth or not
➢ breast fed after ____ hour,
➢ NICU admission
➢ Discharged after _____ days ; sutures removed
on____ day Present age of the child : ___ years
➢ Similar history has to be asked if further pregnancies
are present
FIRST TRIMESTER :
➢ H/O morning sickness
➢ H/O iron and folic acid intake
➢ OGCT done
➢ BP
➢ Dating scan @ 6 weeks and NT scan @11 wks

Dr.Nerve DYNAMIC DIAGNOSERS

 ➢ H/O fever with rashes and pre articular
lymphadenopathy
➢ No H/O irradiation

SECOND TRIMESTER :
➢ Quickening felt at 5 months
➢ Anomaly scan @ 20 weeks
➢ IFA , calcium tablets intake
➢ OGCT ,BP normal
➢ bleeding or discharge per vagina

THIRD TRIMESTER :
➢ Quickening felt
➢ Growth scan @7th month
➢ GCT done at 7th month 🡪 positive , BP 🡪 Normal
➢ bleeding or discharge per vagina

PAST HISTORY :
➢ Diabetic
➢ Hypertensive
➢ Rheumatic heart disease
➢ Thyroid disorder
➢ Seizures
➢ SLE, tb, asthma, allergy ,blood transfusion
➢ H/o surgery
FAMILY HISTORY :
➢ H/O diabetes in her family members

Dr.Nerve DYNAMIC DIAGNOSERS

 ➢ H /O GDM, HT ,pre eclampsia ,twinning
,hemoglobinopathies, congenital amomalies in her
family

PERSONAL HISTORY :
➢ Diet
➢ Sleep and appetite
➢ Bowel habits
➢ Reduced urine output
➢ Adverse social habits
GENERAL EXAMINATION
➢ Patient is conscious, comfortable & cooperative , well
built and nourished.
➢ pallor, icterus, cyanosis ,clubbing , significant
generalized lymphadenopathy.
➢ PEDAL EDEMA
➢ THYROID :
➢ BREAST :
➢ SPINE :
➢ CVS : heart sounds:
➢ added sounds or murmurs.
➢ RS : BAE ,NVBS
VITALS:
➢ Temperature
➢ BP
➢ Pulse rate
➢ Respiratory rate
➢ Anthropometry :
o Height :
o Weight :
Dr.Nerve DYNAMIC DIAGNOSERS
 o B.M.I :
o Pre pregnancy weight :
o Weight gain

➢ Obstetric history
INSPECTION
➢ Uterus enlargement,
➢ Flanks stria gravidarum ,
➢ Linea nigra
➢ Skin stretch
➢ Umbilicus midline
➢ Flushed with the surface
➢ Subumbilical flattening
➢ Suprapubic scar present or
➢ Keloids

PALPATION:
➢ Fundus corresponds to ____weeks of gestation
➢ Fungal grip :
➢ Umbilical grip :
➢ First pelvic grip :
➢ second pelvic grip
➢ Scar tenderness present or not
PERCUSSION:
AUSCULTATION :
➢ Fetal heart sound
➢ Location
➢ Rhythm
➢ Per vaginal examination :
MEASUREMENTS:
➢ Symphysiofundal height :
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ Abdominal girth :
➢ Liqor :
➢ Estimated fetal weight :

DIAGNOSIS

CASE SHEET OF GESTATIONAL DIABETES MELLITUS

Name: Mrs. Madhubala

Age: 24 yrs old
Occupation: Housewife
Socioeconomic class: IV
Address: Perambur
Booked and immunized at perambur PHC
OBSTETRIC SCORE: G3 P1 L1 A1
Last Menstrual Period: 31.1.2018 with regular periods
Expected Delivery Date: 7.11.2018

CHIEF COMPLAINTS
➢ Abdominal pain for 1 day.

HISTORY OF PRESENTING ILLNESS

Abdominal pain ,
➢ Onset : acute
➢ Course:progressive
➢ Duration: past 1 day
➢ Nature: dull aching type
➢ Radiating or not Radiating : not Radiating
➢ Aggravated by food intake
➢ Relieved by sleeping or rest .

Dr.Nerve DYNAMIC DIAGNOSERS

 ➢ The patient gave a H/O positive oral glucose challenge
test at 7 months of gestation at perambur primary
health centre, she was admitted for the safe
confinement of pregnancy in IOG hospital ,egmore
➢ No H/O fever with chills and rigor / burning micturition
➢ H/O vaginal discharge for 1 week , curdy white in colour
,mucous and sticky in consistency, moderate amount ,
not foul smelling or blood stained associated with
itching
➢ No H /O excessive weight gain or excessive enlargement
of the uterus
➢ H/O reduced urinary output
➢ H/O polyphagia
➢ H/O morning sickness
➢ H/O treatment with insulin, morning -10 units
,afternoon -3 units , night -4 units taken half an hour
before each meal

MENSTRUAL HISTORY
➢ Attained menarche at 15 years of age
➢ Regular cycles ,5/28 , 2 to 3 pads / day
➢ No H/O dysmenorrhoea or menorrhagia

MARITAL HISTORY
➢ Married for 5 years
➢ Non consanguineous marriage
➢ No usage of contraception.

Dr.Nerve DYNAMIC DIAGNOSERS

OBSTETRIC HISTORY
FIRST PREGNANCY :
➢ Conceived within 1 year of marriage, spontaneous ,no
contraceptives used
➢ Pregnancy confirmed by UPT at perambur P.H.C.
➢ All trimesters were uneventful
➢ Elective LSCS done , Indication : decreased fetal
movements ?? , postpartum IUCD done
➢ Male baby , birth weight : 1.8 kg, cried immediately after
birth, breast fed after 1 hour,no NICU admission
➢ Post natal period uneventful –no fever ,no pain
➢ Discharged after 5 days ; sutures removed on 7th day .
o Present age of the child : 4 years

SECOND PREGNANCY :
➢ 1year after the first child birth
➢ ABORTION at 1 month of age
➢ Induced ; reason : unexpected pregnancy.

PRESENT PREGNANCY :
➢ After 4 yrs of first child birth ; spontaneous conception ;
contraception not used. Pregnancy confirmed by urine
pregnancy test@ perambur p.h.c.
➢ Booked and immunized at perambur p.h.c.

FIRST TRIMESTER :
➢ H/O morning sickness
➢ No H/O iron and folic acid intake
➢ OGCT done 🡪 normal ,BP recorded and normal
➢ Dating scan @ 6 weeks and NT scan @11 wks
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ No H/O fever with rashes and pre articular
lymphadenopathy
➢ No H/O irradiation
➢ Abortal period uneventful

SECOND TRIMESTER :
• Quickening felt at 5 months

• Anomaly scan @ 20 weeks

• IFA , calcium tablets taken

• OGCT ,BP 🡪 normal

• No bleeding or discharge per vagina

THIRD TRIMESTER :
• Quickening felt
th
• Growth scan @7 month
th
• GCT done at 7 month 🡪 positive , BP 🡪 Normal

• No bleeding or discharge per vagina

PAST HISTORY :
➢ Not diabetic ,hypertensive , rheumatic heart disease,
thyroid disorder, seizures ,SLE, tb ,asthma ,allergy ,blood
transfusion
➢ No h/o surgery

FAMILY HISTORY :
➢ H/O diabetes in her mother
➢ No H /O GDM, HT, pre eclampsia, twinning,
hemoglobinopathies, congenital anomalies in her family
PERSONAL HISTORY :
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ Mixed diet consumer ,normal sleep and appetite,
normal bowel habits, reduced urine output, no adverse
social habits
➢ Patient is conscious, comfortable & cooperative , well
built and nourished.
GENERAL EXAMINATION
➢ No pallor, icterus, cyanosis ,clubbing , significant
generalized lymphadenopathy.
➢ NO PEDAL EDEMA

➢ THYROID : no thyroid nodules.

➢ BREAST : No lump, discharge or nipple retraction
➢ SPINE : normal

➢ CVS : S1,S2 heard . No added sounds or murmurs.

➢ RS : BAE present ,NVBS heard

VITALS:
➢ Temperature : Afebrile
➢ BP: 110/70mm Hg , right upper limb, sitting position
➢ Pulse :75 / min, regular rhythm ,normal volume ,no
specific character ,normal condition of vessel wall ,No
RF & DR delay,all peripheral pulses felt equally on both
sides.

Anthropometry :
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ Height : 158 cm.
➢ Weight :80kg
➢ B.M.I : 32 ( obese )
➢ Pre pregnancy weight : 70 kg
➢ Weight gain : 10 kg

INSPECTION :
➢ Uterus longitudinally enlarged , flanks not full.
➢ Stria gravidarum ,linea nigra seen
➢ Skin not stretched and shiny 🡪 no abdominal wall edema
➢ Umbilicus midline ; flushed with the surface
➢ No subumbilical flattening
➢ Suprapubic scar present ,longitudinal ,healthy ,no
keloids

PALPATION:
➢ Dextrorotation corrected
➢ Fundus corresponds to 32 weeks of gestation
➢ Fungal grip :broad ,soft,bulky,not independently
ballotable part probably breech
➢ Umbilical grip : smooth ,curved ,uniform resistance on
left ,probably back and multiple small nodules felt on
the right probably limb buds
➢ First pelvic grip : Hard ,round ,independently ballotable
part, probably head
➢ Since the head is mobile, second pelvic grip not done
➢ Scar tenderness present.

Dr.Nerve DYNAMIC DIAGNOSERS

PERCUSSION:
No fluid thrill

AUSCULTATION:
➢ Fetal heart sound 140 / min ,heard below the umbilicus
in the left spinoumbilical line, regular in rhythm

Per vaginal examination :

➢ Not done
➢ Symphysiofundal height : 32 cm

Abdominal girth : 110 cm

Liqor :adequate
Estimated fetal weight : 3.1 kg

DIAGNOSIS :
Mrs.Madubala,24 yr old gravida with gestational
diabetes mellitus, with 8 months of amenorrhoea,
previous LSCS with single live foetus with fetal heart of
140 / min in cephalic presentation

Dr.Nerve DYNAMIC DIAGNOSERS

 GESTATIONAL HYPERTENSION
Name
Age
Sex
Occupation
Place
Socioeconomic status
Obstetric score
LMP
EDD
CHIEF COMPLAINTS
➢ Any history of decreased urine output or pain
HISTORY OF PRESENT ILLNESS
➢ The patient was apparently normal ________ back.
➢ Now she came with amenorrhea and raised blood
pressure referred from PHC to RSRM royapuram
➢ H/O lower abdominal pain for 3 days
➢ H/O leg swelling for 2 days aggravated on standing and
relieved by taking rest and not associated with facial
puffiness
➢ H/o decreased urine output
➢ H/O blurring of vision
➢ H/O epigastric pain
➢ H/O vomiting and headache
➢ H/O bleeding / draining PV
Dr.Nerve DYNAMIC DIAGNOSERS
MENSTRUAL HISTORY
➢ Attained menarche at ___
➢ Regular cycle or irregular cycle
➢ Associated with pain or clots or not
MARITAL HISTORY
➢ Married at ____ years of age
➢ H/O taking contraceptives
➢ Degree of consanguinity
OBSTETRIC HISTORY OF PREVIOUS PREGNANCY
➢ 1st baby conceived at ___ years of age
➢ I, II, III trimester – eventful/uneventful
➢ Male/female baby
➢ Baby birth weight
➢ Baby cried immediately or not after birth
➢ H/O postpartum complications
➢ Breast feeding for ______
PRESENT PREGNANCY
➢ Booked and immunised / not
➢ Td vaccination
➢ Antenatal visits
1ST TRIMESTER
➢ Pregnancy was confirmed by
➢ H/O vomiting
➢ H/O fever with rashes
➢ H/O radiation exposure
➢ H/O drug intake
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ H/O bleeding PV
➢ USG done at 3rd month or not
2ND TRIMESTER
➢ Quickening felt at 5th month or not
➢ USG done at 5th month or not
➢ H/O blurring of vision
➢ H/O headache, abdominal pain, leg swelling
➢ H/O polyuria, polydipsia, polyphagia
➢ IFA tablets taken or not
3RD TRIMESTER
➢ Able to perceive foetal movements
➢ USG done at 7th month or not
➢ Bleeding or draining PV
➢ Patient was diagnosed to have hypertension before 2
weeks and is on treatment
PAST HOSTORY
➢ H/O DM, TB, asthma, thyroid disease, IHD, HT
➢ Previous surgery
➢ H/O blood transfusion
FAMILY HISTORY
➢ H/O DM, HT, preeclampsia, twin pregnancy in family
PERSONAL HISTORY
➢ Mixed diet
➢ Normal bowel and bladder habits
➢ No adverse social habits

Dr.Nerve DYNAMIC DIAGNOSERS

GENERAL EXAMINATION
➢ Conscious, oriented to time place and person
➢ Built and nourishment
➢ Pallor
➢ Icterus
➢ Clubbing
➢ Cyanosis
➢ Pedal oedema
➢ Lymphadenopathy
➢ CVS – S1 AND S2 sound heard or not and any murmur
➢ RS – NVBS heard or not, any added sounds
➢ Breast and thyroid
VITALS
➢ Pulse
➢ BP
➢ Respiratory rate
➢ Temperature
➢ Weight Gain in pregnancy
SYSTEMIC EXAMINATION
INSPECTION
➢ Abdomen
➢ Umbilicus
➢ Linea nigra, stria gravidarum
➢ Flanks
PALPATION
➢ Fundal height

Dr.Nerve DYNAMIC DIAGNOSERS

 ➢ Symphysiofundal height
➢ Abdominal girth
➢ Fundal grip
➢ Umbilical grip
➢ 1st pelvic grip
ASCULTATION
DIAGNOSIS

CASE OF GESTATIONAL HYPERTENSION

Name – Mrs.kalpana
Age – 25 yrs
Sex - female
Occupation - housewife
Place - Royapuram
Socioeconomic status – class III
Obstetric score -G2P1L1
LMP – 1/10/22
EDD – 8/7/23
CHIEF COMPLAINTS
➢ The patient came with 9 months of amenorrhea has
been referred from PHC to RSRM hospital for raised
blood pressure

Dr.Nerve DYNAMIC DIAGNOSERS

HISTORY OF PRESENT ILLNESS
➢ The patient was apparently normal 3 days back.
➢ H/O lower abdominal pain for 3 days
➢ H/O leg swelling for 2 days aggravated on standing and
relieved by taking rest and associated with facial
puffiness
➢ No H/o decreased urine output
➢ No H/O blurring of vision
➢ No H/O epigastric pain
➢ No H/O vomiting and headache
➢ No H/O bleeding / draining PV
MENSTRUAL HISTORY
➢ Attained menarche at 14 yrs
➢ Regular cycle 4/28 days – normal flow
➢ Not Associated with pain or clots
MARITAL HISTORY
➢ Married at 21 years of age
➢ No H/O taking contraceptives
➢ No consanguinity history
OBSTETRIC HISTORY OF PREVIOUS PREGNANCY
➢ 1st baby conceived at 22 years of age
➢ I, II, III trimester – uneventful
➢ Male baby
➢ Baby birth weight – 3 kg
➢ Baby cried immediately
➢ No H/O postpartum complications
➢ Breast feeding for 6 months
Dr.Nerve DYNAMIC DIAGNOSERS
PRESENT PREGNANCY
➢ Booked and immunised at RSRM
➢ Td vaccination – doses at 3rd and 5th month
➢ Antenatal visits = 6
1ST TRIMESTER
➢ Pregnancy was confirmed by UPT at RSRM at 40 days
➢ H/O vomiting
➢ No H/O fever with rashes
➢ No H/O radiation exposure
➢ No H/O drug intake
➢ No H/O bleeding PV
➢ USG done at 3rd month
2ND TRIMESTER
➢ Quickening felt at 5th month
➢ USG done at 5th month
➢ No H/O blurring of vision
➢ No H/O headache, abdominal pain, leg swelling
➢ No H/O polyuria, polydipsia, polyphagia
➢ IFA tablets taken
3RD TRIMESTER
➢ Able to perceive foetal movements
➢ USG done at 7th month
➢ No Bleeding or draining PV
➢ Patient was diagnosed to have hypertension before 2
weeks and is on treatment

Dr.Nerve DYNAMIC DIAGNOSERS

PAST HOSTORY
➢ No H/O DM, TB, asthma, thyroid disease, IHD, HT
➢ No Previous surgery
➢ No H/O blood transfusion
FAMILY HISTORY
➢ No H/O DM, HT, preeclampsia, twin pregnancy in family
PERSONAL HISTORY
➢ Mixed diet
➢ Normal bowel and bladder habits
➢ No adverse social habits
GENERAL EXAMINATION
➢ Conscious, oriented to time place and person
➢ Well Built and nourished
➢ No Pallor
➢ No Icterus
➢ No Clubbing
➢ No Cyanosis
➢ No Pedal oedema
➢ No Lymphadenopathy
➢ CVS – S1 and S2 sound heard, no murmur
➢ RS – NVBS heard, no added sounds
➢ Breast and thyroid = normal
VITALS
➢ Pulse – 85/min
➢ BP – 110/70 mm of Hg
➢ Respiratory rate – 15/min
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ Temperature - Afebrile
➢ Weight Gain in pregnancy = 11 kg
SYSTEMIC EXAMINATION
INSPECTION
➢ Abdomen is longitudinally distended
➢ Umbilicus in midline
➢ Linea nigra, stria gravidarum = seen
➢ Flanks full
PALPATION
➢ Fundal height corresponds to 32 weeks of gestation,
flanks full
➢ Symphysio-fundal height = 32 cm
➢ Abdominal girth – 100 cm
➢ Fundal grip – broad, soft podalic pole felt
➢ Umbilical grip
Right – smooth, curved, hard, uniform resistance
felt probably back
Left – multiple small nodules felt, probably limbs
➢ 1st pelvic grip -hard, round, independently, ballotable
mass – probably head
ASCULTATION
➢ FHS heard in left spino umbilical line
➢ Rate = 120/min
➢ Regular rhythm

Dr.Nerve DYNAMIC DIAGNOSERS

DIAGNOSIS
Mrs.kalpana a 26 year old G2P1L1 completed 38 weeks
of gestation whose LMP was 1/10/22 with an EDD of 8/7/23
has single live foetus in cephalic presentation with good FHS.
She is a case of hypertension disorder complicating
pregnancy and is admitted for evaluation and management
of hypertension and for safe confinement of pregnancy

Dr.Nerve DYNAMIC DIAGNOSERS

 NORMAL PREGNANCY
Name
Age
Sex
Occupation
Place
Socioeconomic status
Obstetric score
LMP
EDD
CHIEF COMPLAINTS
➢ Patient came with _____ months of amenorrhea for safe
confinement of pregnancy
HISTORY OF PRESENT ILLNESS
➢ The patient was apparently normal ________ back.
➢ H/O lower abdominal pain
➢ Able to perceive foetal movement
➢ H/O swelling of legs
➢ H/O bleeding/draining PV
MENSTRUAL HISTORY
➢ Attained menarche at ___
➢ Regular cycle or irregular cycle
➢ Associated with pain or clots or not
MARITAL HISTORY
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ Married at ____ years of age
➢ H/O taking contraceptives
➢ Degree of consanguinity
OBSTETRIC HISTORY OF PREVIOUS PREGNANCY
➢ Conceived at ___ years of age
➢ I, II, III trimester – eventful/uneventful
➢ Male/female baby
➢ Baby birth weight
➢ Baby cried immediately or not after birth
➢ H/O postpartum complications
➢ Breast feeding for ______
PRESENT PREGNANCY
➢ Booked and immunised / not
➢ Td vaccination
➢ Antenatal visits
1ST TRIMESTER
➢ Pregnancy was confirmed by
➢ H/O vomiting
➢ H/O fever with rashes
➢ H/O radiation exposure
➢ H/O drug intake
➢ H/O bleeding PV
➢ USG done at 3rd month or not
2ND TRIMESTER
➢ Quickening felt at 5th month or not
➢ USG done at 5th month or not
➢ H/O blurring of vision
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ H/O headache, abdominal pain, leg swelling
➢ H/O polyuria, polydipsia, polyphagia
➢ IFA tablets taken or not
3RD TRIMESTER
➢ Able to perceive foetal movements
➢ USG done at 7th month or not
➢ Bleeding or draining PV
PAST HOSTORY
➢ H/O DM, TB, asthma, thyroid disease, IHD, HT
➢ Previous surgery
➢ H/O blood transfusion
FAMILY HISTORY
➢ H/O DM, HT, preeclampsia, twin pregnancy in family
PERSONAL HISTORY
➢ Mixed diet
➢ Normal bowel and bladder habits
➢ No adverse social habits
GENERAL EXAMINATION
➢ Conscious, oriented to time place and person
➢ Built and nourishment
➢ Pallor
➢ Icterus
➢ Clubbing
➢ Cyanosis
➢ Pedal oedema
➢ Lymphadenopathy
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ CVS – S1 AND S2 sound heard or not and any murmur
➢ RS – NVBS heard or not, any added sounds
➢ Breast and thyroid
VITALS
➢ Pulse
➢ BP
➢ Respiratory rate
➢ Temperature
➢ Weight Gain in pregnancy
SYSTEMIC EXAMINATION
ABDOMINAL EXAMINATION
➢ After obtaining consent from the patient and explaining
the procedure, patient is asked to empty the bladder.
She is examined in dorsal position with thighs semi
flexed and abdomen is exposed from xiphisternum to
pubic symphysis
INSPECTION
➢ Abdomen
➢ Umbilicus
➢ Linea nigra, stria gravidarum
➢ Flanks
➢ Movement of quadrants with respiration
PALPATION
➢ Fundal height
➢ Symphysiofundal height
➢ Abdominal girth

Dr.Nerve DYNAMIC DIAGNOSERS

 Fundal grip
Umbilical grip
1st pelvic grip
ASCULTATION
➢ Foetal heart sounds
➢ Rate
➢ Tone and rhythm
DIAGNOSIS

CASE SHEET OF NORMAL PREGNANCY

Name – Mrs. Bhargavi
Age - 24
Occupation – House wife
Place - karur
Socioeconomic status – class IV
Obstetric score – G2P1L1
LMP – 10/10/22
EDD – 17/7/23

CHIEF COMPLAINTS

Dr.Nerve DYNAMIC DIAGNOSERS

 ➢ Patient came with 9 months of amenorrhea for safe
confinement of pregnancy
HISTORY OF PRESENT ILLNESS
➢ No H/O lower abdominal pain
➢ Able to perceive foetal movement
➢ No H/O swelling of legs
➢ No H/O bleeding/draining PV
MENSTRUAL HISTORY
➢ Attained menarche at 14 yrs
➢ Regular cycle 4/28, moderate flow
➢ No Associated with pain or clots or not
➢ Changes 3 pads per day
MARITAL HISTORY
➢ Married at 18 years of age
➢ Non H/O taking contraceptives
➢ No consanguinity
OBSTETRIC HISTORY OF PREVIOUS PREGNANCY
➢ Conceived at 19 years of age
➢ I, II, III trimester – uneventful
➢ Female baby
➢ Baby birth weight – 2.5 kgs
➢ Baby cried immediately
➢ No H/O postpartum complications
➢ Breast feeding for 6 months

PRESENT PREGNANCY
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ Booked and immunised
➢ Td vaccination at 3rd and 5th
➢ Antenatal visits - 12
1ST TRIMESTER
➢ Pregnancy was confirmed by UPT after 4 weeks of
missed period at GMC
➢ No H/O vomiting
➢ No H/O fever with rashes
➢ No H/O radiation exposure
➢ No H/O drug intake
➢ No H/O bleeding PV
➢ USG done at 3rd month
2ND TRIMESTER
➢ Quickening felt at 5th month
➢ USG done at 5th month
➢ No H/O blurring of vision
➢ No H/O headache, abdominal pain, leg swelling
➢ No H/O polyuria, polydipsia, polyphagia
➢ IFA tablets taken
3RD TRIMESTER
➢ Able to perceive foetal movements
➢ USG done at 7th month
➢ No Bleeding or draining PV
PAST HOSTORY
➢ No H/O DM, TB, asthma, thyroid disease, IHD, HT
➢ No Previous surgery
➢ No H/O blood transfusion
Dr.Nerve DYNAMIC DIAGNOSERS
FAMILY HISTORY
➢ No H/O DM, HT, preeclampsia, twin pregnancy in family
PERSONAL HISTORY
➢ Mixed diet
➢ Normal bowel and bladder habits
➢ No adverse social habits
GENERAL EXAMINATION
➢ Conscious, oriented to time place and person
➢ Well Built and nourished
➢ No Pallor
➢ No Icterus
➢ No Clubbing
➢ No Cyanosis
➢ No Pedal oedema
➢ No Lymphadenopathy
➢ CVS – S1 AND S2 sound heard, no murmur
➢ RS – NVBS heard, no added sounds
➢ Breast and thyroid = normal
VITALS
➢ Pulse – 85/min
➢ BP – 120/80 mm of Hg
➢ Respiratory rate – 19/min
➢ Temperature – afebrile
➢ Weight Gain in pregnancy – 11 kgs
SYSTEMIC EXAMINATION
ABDOMINAL EXAMINATION

Dr.Nerve DYNAMIC DIAGNOSERS

 ➢ After obtaining consent from the patient and explaining
the procedure, patient is asked to empty the bladder.
She is examined in dorsal position with thighs semi
flexed and abdomen is exposed from xiphisternum to
pubic symphysis
INSPECTION
➢ Uterus longitudinally enlarged
➢ Umbilicus in midline
➢ Linea nigra, stria gravidarum seen
➢ Flanks are full
➢ All quadrants moves equally with respiration
PALPATION
➢ Fundal height corresponds to 32 weeks of gestation
➢ Symphysiofundal height 33 cms
➢ Abdominal girth – 102 cms
Fundal grip
Broad, soft bulky not independently ballotable mass felt
suggestive of breech occupying the fundus.
Umbilical grip
left side :- smooth curved uniform resistance resistance
felt, suggestive of spine
right side :- multiple small nodule like structure felt,
suggestive of limb buds
1st pelvic grip

Dr.Nerve DYNAMIC DIAGNOSERS

 Hard, round, independently ballotable occupying the
lower pole of uterus, suggestive of foetal heard.
ASCULTATION
➢ Foetal heart sounds heard in left spino umbilical line
➢ Rate – 140/min
➢ Tone and rhythm normal
DIAGNOSIS
➢ A 24 year old female, Mrs Bhargavi G2P1L1 with 37 weeks
of gestation with LMP on 10/10/2022 and EDD on
17/7/2023 who on examination has a single live foetus in
cephalic presentation with good foetal heart sounds has
been admitted for safe confinement of pregnancy.

Dr.Nerve DYNAMIC DIAGNOSERS

 Rh NEGATIVE PREGNANCY
Name:
Age :
Address:
Occupation:
Socio-economic class :
LMP:
EDD:

CHIEF COMPLAINTS

HISTORY OF PRESENTING ILLNESS

➢ H/o leaking PV
➢ H/o bleeding PV
➢ H/o burning micturition
➢ H/o swelling of legs
➢ H/o blurring of vision
➢ H/o epigastric pain

HISTORY OF PRESENT PREGNANCY:

➢ H/o Indirect Coombs test
➢ H/o husband blood group

Dr.Nerve DYNAMIC DIAGNOSERS

1st trimester :
➢ H/o folic acid

2nd trimester:
➢ Quickening
➢ H/o iron and folic acid
➢ Anomaly scan
➢ Two doses of tetanus toxoid
3rd trimester:
➢ Perception of fetal movements
➢ Fe and Ca supplements
Menstrual history:
➢ Menarche
➢ Days of menses
➢ Normal
➢ Regular /irregular flow
Marital history :
➢ Duration of marriage
➢ Non Consanguineous/Consanguineous marriage .
➢ h/o infertility.
Past Obstetric history :
➢ H/o past Pregnancy .
Past History :
➢ H/o HTN,DM,Epilepsy,TB,Asthma or heart disease.
➢ H/o blood transfusion in past .

Dr.Nerve DYNAMIC DIAGNOSERS

Personal history :
➢ H/o adverse social habits.

Examination
General Examination:
➢ Conscious ,oriented and coherent
➢ Moderately built and nourished
➢ Ht:
➢ Wt:
➢ Pallor, icterus ,cyanosis ,clubbing ,lymphadenopathy
and pedal edema.
➢ Breast examination :
➢ Thyroid examination:
➢ Tongue ,teeth ,gums
➢ Cvs :
➢ Rs breath sounds heard.
➢ Cns :nfnd

VITALS
➢ Temperature :
➢ Pulse :
➢ RR:
➢ BP:
➢ Weight before pregnancy :
➢ Current weight :

Dr.Nerve DYNAMIC DIAGNOSERS

Obstetric examination
Inspection :
➢ Height of fundus
➢ Symphysio-fundal height
➢ Abdominal girth
➢ Fundal grip
➢ Umbilical grip
➢
Auscultation
➢ Rate
➢ Tone
➢ Rhythm

Diagnosis

CASE SHEET OF Rh NEGATIVE PREGNANCY

Name: Aruna
Age :28
Address: Porur,Chennai
Occupation: Cottage Industry
Socio-economic class : Lower Middle class
LMP:12th November,2020
EDD:23rd August,2021
Dr.Nerve DYNAMIC DIAGNOSERS
G3P1A1L1
Booked and immunised

HISTORY OF CHIEF COMPLAINTS:

➢ Patient came to OP with the history of 8 months of
amenorrhea being referred from Porur PHC.

HISTORY OF PRESENTING ILLNESS:

➢ Case of rh negative mother ( o negative)
➢ H/o adverse fetal outcome in previous pregnancies due
to hemolytic disease of fetus and newborn.
➢ No h/o leaking pv
➢ No h/o bleeding pv
➢ No h/o burning micturition
➢ No h/o swelling of legs
➢ No h/o blurring of vision
➢ No h/o epigastric pain
➢ History of Present Pregnancy:
➢ H/o Indirect Coombs test-elevated titers denoting Rh
isoimmunisation, in titers taken between every 4 week
interval.( titer greater than 1:16)
➢ H/o husband blood group: O positive

1st trimester :

Dr.Nerve DYNAMIC DIAGNOSERS

 ➢ Pregnancy confirmed on January 2nd in nearby PHC
through Pregnancy confirmation test(Beta HCG test ).
➢ Dating scan done with normal findings
➢ H/o hyperemesis treated by Ondansetron 8mg BD
➢ H/o folic acid intake
2nd trimester:
➢ Quickening felt in 18 weeks
➢ H/o iron and folic acid tablet intake
➢ Anomaly scan done –no abnormalities found
➢ Two doses of tetanus toxoid taken
3rd trimester:
➢ Perception of fetal movements present.
➢ Fe and Ca supplements taken.
Menstrual history:
➢ Attained menarche at 13 years, 4-5 days of menses /30
days ,normal, regular flow, no clots, no dysmenorrhea.
Marital history :
➢ Duration of marriage : 5 years
➢ Non Consanguineous marriage.
➢ No h/o infertility.

Past Obstetric history :

Dr.Nerve DYNAMIC DIAGNOSERS

H/o 1st Pregnancy:
➢ Resulted in miscarriage in 16 weeks
➢ No Anti D given after miscarriage episode
➢ No ICT done
H/o 2nd Pregnancy :
➢ Mothers blood group as O negative and Fathers blood
group as O positive detected.
➢ h/o Anti D prophylaxis around 28-30 weeks given as
prophylaxis.-300micro gram given
➢ Serial of Indirect Coombs test done showing low levels
of titre(<1:8)
➢ h/o normal delivery of fetus at term, with mild HDFN
➢ Postpartum Anti D -300 micro gram given.
➢ No h/o exchange transfusion
➢ h/o normal delivery of fetus, with mild HDFN, no h/o
Neonatal jaundice/Anemia.
➢ Postpartum Anti D -300 micro gram given.
➢
Past History :
➢ No h/o HTN,DM,Epilepsy,TB,Asthma or heart disease.
➢ No h/o blood transfusion in past .

Personal history :
➢ No h/o adverse social habits.

General Examination:
Dr.Nerve DYNAMIC DIAGNOSERS
 ➢ Patient is conscious ,oriented and coherent
➢ Moderately built and nourished
➢ Ht: 160 cm
➢ Wt: 60 kg
➢ No pallor, no icterus ,cyanosis ,clubbing
,lymphadenopathy and pedal edema.
➢ Breast examination :normal
➢ Thyroid examination: normal
➢ Tongue ,teeth ,gums:normal
➢ CVS : No murmurs heard
➢ RS :normal b/l vesicular breath sounds heard.
➢ CNS :NFND

VITALS
➢ Temperature :afebrile
➢ Pulse : 78/minute
➢ RR: 11/ min
➢ BP:120/80 mm Hg
➢ Weight before pregnancy :51
➢ Current weight : 60

Inspection :
➢ Uterus longitudinally enlarged
➢ Linea nigra ,striae gravidarum seen
➢ All quadrants move equally with respiration
Palpation:

Dr.Nerve DYNAMIC DIAGNOSERS

 ➢ Height of fundus : bigger than corresponding period of 8
months amenorrhea suspecting Polyhydramnios
➢ Symphysio-fundal height:37 cm,32 weeks
➢ Abdominal girth:85 cm,32 weeks
➢ Fundal grip : Broad ,soft ,not independently ballotable
,probably breech felt
➢ Umbilical grip: Right side –multiple small nodules,
probably limb nodes, left side –smooth curved resistant
back-probably spine.
➢ 1 st pelvic grip : hard ,round ,independently ballotable
fetal part ,probably head occupying the lower pole of
Uterus.
➢ Head is floating

Auscultation :
➢ FHS heard on the left spine umbilical line
➢ Rate : 120-140/min
➢ Normal tone ,regular rhythm.

Summary:
➢ Subject named Aruna aged 28 years, Rh negative
G3P1A1L1, booked and immunized ,with EDD of 23rd
August,2021 has come to OPD,IOG with period of
gestation 32 weeks with history of administration of Anti
D postpartum of 2nd pregnancy, current pregnancy with
polyhydramnios, with head in lower pole of uterus ,head

Dr.Nerve DYNAMIC DIAGNOSERS

 floating, not engaged with foetal heart rate between 120
to 140 /min

Diagnosis:
➢ Rh negative G3P2A1L1 with 8 months period of
gestation with head presentation in the lower pole of
Uterus with 120 to 140 FHR/min with polyhydramnios.

Dr.Nerve DYNAMIC DIAGNOSERS

TEAM OF DYNAMIC DIAGNOSERS…..

AARTHIKA MYTHILI PRIYA

AKSHAYA NIRMAL
GEETHANJALI PRAVITHA
JAMEEN SNEHA
KRISHNA KUMAR SOWMIYA RAJ
MAMTA SURJITH
MOONITHA SUVEETHA

TEAM IMPULSE…..
MUKESH KANNA

Dr.Nerve DYNAMIC DIAGNOSERS

You can find us at

dr.nerve

t.me/drnervekgmc

dr.nerve

dr.nerve

[email protected]

Dr.Nerve DYNAMIC DIAGNOSERS

Dr.Nerve DYNAMIC DIAGNOSERS