CASE PRESENTATION
Presenters – Dr Shreya
Dr Saieswari
JNMC, Belagavi
• A 25 year old lady hailing from kakati, housewife by occupation, belonging to
lower middle class according to modified B.G. Prasad classification presented to
Out patient department
HISTORY OF PRESENT PREGNANCY
• H/O of 8 months of amenorrhea
• Appreciating fetal movements well.
• Patient came with complaints of generalized weakness and easy fatiguability since 2
months
• No complaints of pain abdomen, pv bleeding , pv leak, headache, nausea, vomiting ,
epigastric pain, syncopal attacks
• No c/o palpitation, breathlessness, chest pain
• No c/o haematemesis, haemoptysis.
• No c/o black coloured stools.
• No c/o yellowish discolouration of eyes.
• No c/o blood transfusion,
• No c/o edema (generalised/ pedal)
• No c/o tingling/ numbness
• No c/o burning micturition.
• No c/o chronic fever
ANTENATAL HISTORY
Regular ANC visits taken at PHC
2 ANC visits @ KLEH
Unregistered case in KLEH
1st trimester
Spontaneous conception.
• Pregnancy detected by UPT at 1 &1/2 months of amenorrhea.
• Dating scan done – no [Link].
• Tab folic acid supplements taken.
• No history of Fever with Rash, burning micturition & increased frequency of micturition, per vaginal
bleeding, excessive vomiting, pain abdomen.
2nd trimester-
• Quickening felt at 5 months of amenorrhea.
• Tab. Iron and Calcium supplements taken
• [Link] 2 doses taken.
• Anomaly scan done - No gross anomalies.
• Diagnosed with hypothyroidism since 4th MOA on Tab Thyronorm 25mcg 1-0-0
• No H/o pain abdomen/ PV bleed/ PV leak / headache/ blurring of vision/ vomiting/
epigastric pain
3rd trimester-
• Appreciating fetal movements well.
• Tab iron and calcium supplements continued.
• Growth scan – Normal growth and liquor noted.
• No H/o pain abdomen/ PV bleed/ PV leak / headache/ blurring of vision/ vomiting/
epigastric pain
Obstetric history- Married life – 4 years (Non consanguineous marriage)
Obstetric score - G2P1L1
P1- FT Emg LSCS/ F/ 3.2kg/ A&H/ 2.5 yrs ago @ bailhongal PHC (I- MSL)
Menstrual history- Menarche- 13 years
Menstrual cycle- Regular/ 3-4 days/28 days/ moderate flow
No h/o passage of clots and dysmenorrhea
Last menstrual period - 27/07/2023
Expected delivery date-02/05/2024
Period of gestation- 33 weeks 6 Days
Past history- Not a known case of diabetes mellitus, chronic hypertension,
tuberculosis, asthma, epilepsy, cardiac disease, renal disease, no history of previous
surgeries , drug allergy, blood transfusions in past.
Family history- Nothing significant
Personal history- Mixed diet
Sleep and appetite adequate
Bowel and bladder habits regular
DIETARY HISTORY
Total calorie intake – 2175 cal
Protein- 65 gm
Deficit- 425 cal and protein deficit - 21.3
GENERAL PHYSICAL EXAMINATION
• Patient is moderately built & nourished
• PR- 98 bpm ,regular, good volume.
• BP-120/70 mm Hg, right brachial artery, sitting position
• Temp – 98.2 F
• Pallor – present (+)
• Koilonychia, platynychia - absent
• Icterus, bilateral pitting pedal edema- absent
• Examination of Thyroid , Breast , Spine appeared Normal
• Height - 152cm
• Weight - 52kg
• BMI - 22 kg/m2
SYSTEMIC EXAMINATION :
• CVS - S1S2 heard. No murmurs
• RS - Bilateral Normal vesicular breath sounds heard
PER ABDOMEN EXAMINATION
INSPECTION
• Abdomen uniformly distended.
• Umbilicus inverted.
• Striae gravidarum present.
• Linea nigra present.
• No dilated vein
• Pfannenstiel incision scar +
PALPATION
• Uterus 32 weeks size.
• Fundal grip - soft, broad, non-ballotable mass felt suggestive of breech.
• Lateral grip-
Left side - smooth, uniformly resistant curved structure suggestive of fetal spine
Right side- Irregular knob like structures felt suggestive of limbs.
• 1st pelvic grip - hard, round, ballotable mass suggestive of head
• 2nd pelvic grip- findings confirmed, converging
Auscultation-FHS was heard in left spino-umbilical line
Rate- 140 Bpm, Regular.
INVESTIGATIONS
BLOOD GROUP – O POSITIVE
HB : 8.3 G/DL
[Link] :3.15mciu/ml
PCV : 30.4 % FBS- 92
PPBS- 104
PLATELETS : 2.56L
Urine Routine and Microscopy : NAD
TLC : 10,900 HIV: Non Reactive
N/L/E/M- 86/10/1/3
HBSAG: Non Reactive
P/S : Microcytic hypochromic anemia with
neutrophilic leucocytosis
PROVISIONAL DIAGNOSIS
G2P1L1 with 33 weeks 6 days with cephalic presentation
with previous LSCS with moderate anemia.
SUMMARY
A 25 years old G2P1L1 with 33 weeks 6 days POG with cephalic presentation with
previous LSCS belonging to lower middle class according to modified B.G. Prasad
classification, came with c/o with complaints of generalized weakness and easy
fatiguability since 2 months
On examination : Pallor noted
THANK YOU
