Obstetrics N Gynaecology Cases PDF
Obstetrics N Gynaecology Cases PDF
Obstetrics N Gynaecology Cases PDF
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CLINICAL CASES (GYNAECOLOGY)
CLINICAL CASES (OBSTETRICS)
GALLERY
PRACTICAL OBG
SAMPLE CHAPTERS
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No BABY AT PRESENT
. DELIVERY BIRTH AGE COMMENTS
Baby cried
soon after
birth, Booked &
Female, 3 Immunized(Had 3
FTND, kg, Breast ANC visits + TT +
Government fed – 2 ½ 10 years IFA)Post partum
G2 Hospital years period – normal
LMP – 02/11/2006
EDD – 09/07/2007
PRESENT PREGNANCY
T1
No history of nausea, vomiting or weakness.
No urinary symptoms
No drug intake
No history of craving for abnormal food (pica)
T2
Quickening in 5th month
1st ANC visit – 20 weeks, given TT & IFA tablets (consumed)
T3
Fetal movements present
No leak or bleed PV
No h/o pain abdomen
CONTRACEPTIVE HISTORY:
No history of using any contraceptive methods.
MENSTRUAL HISTORY:
Age of Menarche – 13 years
Past Cycles – Regular 30 days cycles with flow lasting 5 days, normal quantity, no pain or passing of
clots.
LMP – 02/11/2006
FAMILY HISTORY:
No history of congenital anomalies or twinning, DM, HTN
PAST HISTORTY:
No history of Tuberculosis, Epilepsy, Asthma
No history suggestive of any cardiac ailments.
No history of previous surgeries, blood transfusions.
PERSONAL HISTORY:
Diet – Mixed
Appetite – Good
Sleep – Sound
Bowel & Bladder – Regular
Habits – Nil
DIET HISTORY:
Consumes – 2100 kcal/day
Required – 2400 kcal/day
Deficit – 300 kcal/day
Pallor – Present
Icterus – Absent
Cyanosis – Absent
Clubbing – Absent
Edema – Absent
Lymphadenopathy – Absent
Thyroid – Normal
Breasts – Normal
Spine – Normal
Height – 146 cm
Weight – 56 kg
BMI – 26.27
SYSTEMIC EXAMINATION:
CVS – S1 S2 heard, No murmurs.
RS – NVBS heard, no basal crepts.
CNS – NAD.
PA – Normal bowel sounds heard
OBSTETRIC EXAMINATION:
INSPECTION:
Abdomen is uniformly distended, globular in shape
Umbilicus everted, hernial orifices normal
Flanks do not appear to be full
Stria gravidarum and linea nigra present
No scars over the abdomen
PALPATION:
Abdominal circumference – 76 cm
Symphysio-fundal height – 28 cm (corresponds to 32 weeks)
FUNDAL GRIP – Soft, broad & non-ballotable, suggestive of breech
Lateral Grip – Knob like structures on the right side suggestive of limb buds
Uniform resistance on the left side suggestive of spine
1ST PELVIC GRIP – Smooth, hard, ballotable mass suggestive of head
2ND PELVIC GRIP – Fingers converge, head not engaged.
Uterus is relaxed
Fetal age = 28*8/7 = 32 weeks
Fetal weight = (28-12)*155 = 2480 gm
AUSCULTATION:
Fetal Heart sounds heard along the left spino-umbilical line
142/min, regular, rhythmic
DIAGNOSIS:
30 year old G3P2L2A0 with 32 weeks of gestation, moderate anemia probably due to iron deficiency,
not in labour with no clinical signs of failure.
**********************************************
PREVIOUS PREGNANCY
G1 :
Painless spontaneous abortion at 6th month following bleeding PV. Patient had gone for 4 ANC
visits, 2 scans, booked and immunized.
No history of excessive vomiting. (Rule out H. mole)
No history of HTN during pregnancy.
PRESENT PREGNANCY
T1
Morning sickness for 2 months – present.
Increased frequency of micturation – present.
No history of easy fatiguability.
No history of discharge or bleed PV.
No history of drug intake or radiation exposure.
No history of Pica.
T2
Quickening at 5th month.
No history of headache, blurred vision or sudden increase in weight.
Booked and Immunized – 3 ANC visits, 2 TT, 100 IFA, Scan done at 20 th week.
T3
Fetal movements present.
No history of bleeding or discharge PV.
No history of pain abdomen.
Generalized edema – present.
Last abortion – 1 year back.
MENSTRUAL HISTORY:
Age of Menarche – 16 years
Past Cycles – Regular, 30 day cycle, 4 days flow, no pain or passage of clots.
LMP – 03/11/06
No history of any contraceptives used.
FAMILY HISTORY: No history of DM, HTN, asthma, twinning in family. No history of PIH in mother or
sister.
PAST HISTORTY:
Medical – No history suggestive of DM/HTN.No history of TB, epilepsy or asthma.
Surgical – No history of blood transfusions or any previous surgical procedures.
PERSONAL HISTORY:
Diet – Mixed
Appetite – Good
Sleep – Sound
Bowel & Bladder – Regular
Habits – Nil
Pallor – Present
Icterus – Absent
Cyanosis – Absent
Clubbing – Absent
Edema (pedal) – Present, Pitting in nature
Lymphadenopathy – Absent
Thyroid – Normal
Breasts – Normal
Spine – Normal
Gait – Normal
Height – 160 cm
Weight – 70 kg
BMI – 27.3
SYSTEMIC EXAMINATION:
CVS – S1 S2 heard, no murmurs.
RS – NVBS heard, no additional sounds heard.
CNS – Knee jerk – present. Sensory, motor and cranial nerves – normal.
PA – Normal bowel sounds heard
OBSTETRIC EXAMINATION:
INSPECTION:
Abdomen uniformly distended.
Flanks not full.
Umbilicus – everted.
Striae gravidarum, albicans & linea nigra – present.
No scars over abdomen, no dilated veins.
Hernial orifices – normal.
PALPATION: (Patient examined in supine position with legs semi flexed).
Fundal height corresponds to 32 weeks gestation.
SFH is 28 cm, abdominal circumference – 85 cm.
Fundal grip – Smooth, broad irregular structure suggestive of breech.
Lateral Grip – Right – Knob like structures suggestive of limb buds.
Left – Uniform curved resistance suggestive of spine.
1st Pelvic Grip – Smooth, round, hard ballotable mass (not engaged) suggestive of head felt at
lower pole
AUSCULTATION:
FHS heard along the left spino-umbilical line, mid point.
Rate – 146/min, regular.
DIAGNOSIS:
20 year old G2A1 with 32 weeks gestation, single live fetus with cephalic presentation with head
not engaged and not in labour, with mild pre-eclampsia (on treatment) complicating her
pregnancy.
**********************************************
PREVIOUS PREGNANCY:
T1
History of increased vomiting – present.
History of easy fatigability.
No history of urinary symptoms.
No history of drug intake or radiation exposure.
No history of pica.
T2
Quickening at 20th week.
History of generalized edema – present.
No history of headache or blurring of vision.
Patient was booked and immunized – 6 ANC checkups, 2 USG scans, 2 TT & 100 IFA.
T3
Fetal movements present.
Uneventful.
Delivered by Lower Segment Caesarean Section probably due to obstructed labour or non-
progression of labour.
Patient was initially put n trial of labour by administering injections, but since labour pains were
not adequate, she was posted for emergency LSCS, after infusing 1 unit of blood.
Outcome was a live male fetus, 3.7 kg at birth, was immunized and exclusively breast fed for 1
year.
Mother had no fever or wound discharge in the post-op period.
Sutures were removed on the 7th day but had to stay in the hospital for 16 days as the baby had
jaundice.
Last C-section – 3 years back (April 25th, 2004)
PRESENT PREGNANCY: T1, T2 and T3 uneventful. EDD-08/08/07
CONTRACEPTIVE HISTORY:
No history of using any contraceptive methods.
MENSTRUAL HISTORY:
Age of Menarche – 12 years
Past Cycles – Regular, 50-70 day cycle, 8-9 days flow, no pain or passage of clots.
LMP – 01/11/06
No history of any contraceptives used.
PERSONAL HISTORY:
Diet – Mixed
Appetite – Good
Sleep – Sound
Bowel & Bladder – Regular
Habits – Nil
Pallor – Present
Icterus – Absent
Cyanosis – Absent
Clubbing – Absent
Edema – Absent
Lymphadenopathy – Absent
Thyroid – Normal
Breasts – Normal
Spine – Normal
Gait – Normal
Height – 158 cm
Weight – 51 kg
SYSTEMIC EXAMINATION:
CVS – S1 S2 heard, No murmurs.
RS – NVBS heard, no basal crepts.
CNS – NAD.
PA – NAD
OBSTETRIC EXAMINATION:
INSPECTION:
Distended and flanks are full.
Umbilicus – normal.
Striae gravidarum, albicans & linea nigra – present.
No dilated veins.
Hernial orifices – normal.
A vertical right paramedian incision, 14 cm long is seen in the infra-umbilical region, healed by
primary intention – no hypertrophy or keiloid formation, no supra-pubic bulge.
PALPATION: (Patient examined in supine position with legs semi flexed).
Fundal height corresponds to 32 weeks with flanks full – corresponding to 40 weeks of gestation.
SFH is 32cm.
Fundal grip – Broad, soft irregular structure suggestive of breech.
Lateral Grip – Right – Knob like structures suggestive of Limb buds.
Left – Uniform curved resistance suggestive of spine.
1st Pelvic Grip – Smooth, hard ballotable mass.
2nd Pelvic Grip – Fingers diverge.
Abdominal girth – 95 cm.
Weight of the fetus (Johnson’s formula) = 3260 gm.
Age of fetus (Mc Donald’s formula) = 40 weeks.
No scar tenderness.
No supra-pubic bulge felt.
AUSCULTATION:
FHS heard along the left spinoumbilical line, mid point.
Rate – 140/min, regular.
DIAGNOSIS:
23 year old G2P1L1 with full term single intrauterine pregnancy with previous LSCS with
longitudinal lie with cephalic presentation not in labour.
**********************************************
PREVIOUS PREGNANCY:
FTD at home, cried soon after birth, weight not measured.
Booked & Immunized, 5 ANC visits, 2 TT & 100 IFA.
The baby died 2 days after birth due to unknown reasons.
PRESENT PREGNANCY
T1
Morning sickness for 2 months.
No history of Urinary symptoms.
No history of Drug intake.
No history of Pica.
T2
Quickening at 20th week.
No history of headache, blurred vision.
2 ANC visits, 2 TT, 100 IFA, 2 scans.
T3
Fetal movements present.
No bleeding/leak PV.
In this pregnancy, she was evaluated & her blood group turned out to be B –ve while that of the
fetus was O +ve
No Anti – D injection given.
No history of abortion, LSCS or IUFD or invasive fetal procedure.
Previous baby blood group not known.
Last delivery – 2 years back.
CONTRACEPTIVE HISTORY:
No history of using any contraceptive methods.
MENSTRUAL HISTORY:
Age of Menarche – 15 years
Past Cycles – Regular, 30 day cycle, 4 days flow, no pain or passage of clots.
LMP – 04/12/06
PERSONAL HISTORY:
Diet – Mixed
Appetite – Good
Sleep – Sound
Bowel & Bladder – Regular
Habits – Nil
Pallor – Absent
Icterus – Absent
Cyanosis – Absent
Clubbing – Absent
Edema – Absent
Lymphadenopathy – Absent
Thyroid – Normal
Breasts – Normal
Spine – Normal
Gait – Normal
Height – 156 cm
Weight – 60 kg
SYSTEMIC EXAMINATION:
CVS – S1 S2 heard, No murmurs.
RS – NVBS heard, no basal crepts.
CNS – NAD.
PA – NAD
OBSTETRIC EXAMINATION:
INSPECTION:
Abdomen uniformly distended.
Flanks not full.
Umbilicus – normal.
Striae gravidarum, albicans & linea nigra – present.
No scars over abdomen, no dilated veins.
Hernial orifices – normal.
PALPATION: (Patient examined in supine position with legs semi flexed).
Fundal height corresponds to 28 weeks gestation.
SFH is 25 cm.
Fundal grip – Smooth, broad irregular structure suggestive of breech.
Lateral Grip – Right – Knob like structures suggestive of Limb buds.
Left – Uniform curved resistance suggestive of spine.
1st Pelvic Grip – Smooth, round, hard ballot able mass (not engaged) suggestive of Head felt at
lower pole.
AUSCULTATION:
FHS heard along the left spinoumbilical line, mid point.
Rate – 140/min, regular.
DIAGNOSIS:
22 year old G2P1Lo with 7 months amenorrhea, single live fetus, not in labour with Rh –ve
pregnancy.
**********************************************
PREVIOUS PREGNANCY:
G1 – FTND, Government Hospital, Now 11 years, Cried soon after birth, Weighed 3 kg, Post partum
period normal, Booked and immunized, 3 ANC visits, 2TT & 100 IFA received.
G2 – Aborted at 1½ months gestation (MTP) 6 years ago.
PRESENT PREGNANCY:
T1
History of nausea and vomiting.
No history of urinary symptoms.
No history of drug intake or radiation exposure.
No history of pica.
T2
Quickening at 18th week.
No history of headache or blurring of vision or edema.
Patient was booked and immunized – 4 ANC checkups, 2 TT & 100 IFA.
T3
Increased frequency of micturItion – present.
Fetal movements present.
Uneventful.
CONTRACEPTIVE HISTORY:
No history of using any contraceptive methods.
MENSTRUAL HISTORY:
Age of Menarche – 15 years
Past Cycles – Regular, 30 day cycle, 3 days flow, no pain or passage of clots.
LMP – 15/10/06
FAMILY HISTORY: No history of DM, HTN. No history of any congenital heart disease among relatives.
PAST HISTORTY:
Patient underwent a cardiac surgery 2 years back when she developed sudden onset of
breathlessness though she was on medical treatment for some cardiac ailment for 5 years. Her
previous reports revealed that she was diagnosed to have RSOV with VSD. She underwent the
operation in a government hospital in Putbarti.
No history of fleeting joint pains or fever in the childhood and patient not on penidure prophylaxis.
No history of any post-op complications.
No history suggestive of DM or HTN.
No history of TB, epilepsy or asthma.
PERSONAL HISTORY:
Diet – Mixed
Appetite – Good
Sleep – Sound
Bowel & Bladder – Regular
Habits – Nil
Pallor – Absent
Icterus – Absent
Cyanosis – Absent
Clubbing – Absent
Edema – Absent
Lymphadenopathy – Absent
Thyroid – Normal
Breasts – Normal
Spine – Normal
Gait – Normal
Height – 160 cm
Weight – 60 kg
SYSTEMIC EXAMINATION:
CARDIO-VASCULAR SYSTEM:
INSPECTION
No precordial bulge.
Apical impulse – left 4th inter-costal space, 2 cm lateral to Mid-cavicular line.
No other abnormal pulsations.
A linear scar seen over the mid-sternum 15 cm × 2 cm.
No dilated veins over the chest wall.
PALPATION
Inspectory findings were confirmed.
Apex beat – left 4th inter-costal space, 2 cm lateral to Mid-cavicular line.
No parasternal heave.
No thrill felt.
No abnormal pulsations.
AUSCULTATION
CVS
Aortic area
Pulmonary area
Mitral area
PRESENTING COMPLAINTS:
Pain abdomen – 13 days.
Swelling of both lower limbs – 13 days.
Chest pain and breathlessness – 8 days.
HISTORY OF PRESENTING COMPLAINTS:
Patient gives history of pain abdomen for the past 13 days, over the lower part of the abdomen,
moderate intensity, intermittent in nature, each episode lasting about 2 hours and approximately 2-3
episodes per day, relived on medication.
Patient also complaints of swelling of both the lower limbs since 13 days, insidious in onset,
initially present over the feet and has gradually progressed to the knee, present throughout the day,
increases on walking and relived on taking rest. No diurnal variation. No history of distention of
abdomen or puffiness of face.
Patient also gives a history of chest pain since last 8 days, sudden in onset, over the retrosternal
region, progressive, constricting type, non-radiation, moderate severity, aggravated on exertion and
relieved on rest. It is associated with breathlessness, insidious in onset, progressive in nature, initially
patient was able to do her routine activities but now she gets breathless after walking a few meters. It
is relieved on rest.
History of palpitations present.
No history of bleeding or discharge per vagina.
No history of orthopnea, PND.
No history suggestive of CCF, Infective endocarditis.
No history of fever.
No history suggestive of thyroid disease.
No history of any cardiac disease
Not a known case of DM or HTN.
OBSTETRIC HISTORY:
Married Life – 1 years (non – consanguineous marriage)
Parity index – primigravida
LMP – 03/03/07
EDD – 10/12/07
PRESENT PREGNANCY:
T1
History of nausea and vomiting.
History of urinary symptoms – present.
No history of drug intake or radiation exposure.
No history of pica, Booked and Immunized.
T2
Quickening at 5th month.
No history of headache or blurring of vision or edema.
T3
Fetal movements present.
Developed swelling of both lower limbs, chest pain and breathlessness as mentioned previously.
CONTRACEPTIVE HISTORY:
No history of using any contraceptive methods.
MENSTRUAL HISTORY:
Age of Menarche – 15 years
Past Cycles – Regular, 30 day cycle, 3 days flow, no pain or passage of clots.
LMP – 03/03/07
FAMILY HISTORY: No history of DM, HTN. No history of any congenital heart disease among relatives.
PAST HISTORTY:
No history of fleeting joint pains or fever in the childhood and patient not on penidure prophylaxis.
No history suggestive of any other congenital heart disease.
No history of heart surgery.
No history suggestive of DM or HTN.
No history of TB, epilepsy or asthma.
No history of previous hospitalization or treatment for heart ailments.
PERSONAL HISTORY:
Diet – Mixed
Appetite – Good
Sleep – Sound
Bowel & Bladder – Regular
Habits – Nil
Pulse – 99/min, regular, good volume, normal character, all PP felt. JVP– raised (6 cm).
BP – 126/90 mm of Hg in left upper limb in supine position.
RR – 18/min, regular, TA
Temperature – Patient is afebrile
Pallor – Absent
Icterus – Absent
Cyanosis – Absent
Clubbing – Absent
Edema – Absent
Lymphadenopathy – Absent
Thyroid – Normal
Breasts – Normal
Spine – Normal
Gait – Normal
Height – 160 cm
Weight – 60 kg
SYSTEMIC EXAMINATION:
CARDIO-VASCULAR SYSTEM:
INSPECTION
No precordial bulge.
Apical impulse – left 4th inter-costal space, 2 cm lateral to Mid-cavicular line.
No other abnormal pulsations.
No dilated veins over the chest wall, no scars.
PALPATION
Inspectory findings were confirmed.
Apex beat – left 4th inter-costal space, 2 cm lateral to Mid-cavicular line.
Parasternal heave – present.
No thrill felt.
No abnormal pulsations.
AUSCULTATION
CVS
1.
Ashi
May 2, 2011 at 8:15 pm
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2.
ramya
January 10, 2013 at 12:22 am
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3.
Hasna
June 13, 2013 at 11:18 pm
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