Case Presentation

ANC
Group 3
Maryam Kidwai- 190201031
Ritika Bhatia- 190201032
Rhea Simon- 190201033
Anirudh Nambiar-190201034
Snehi Sinha-190201036
Akhil Pillai-190201037
Manvi Shahi-190201038
Adith Bondugula-190201039
Aparna Mohan K-190201040
Amrita -190201041
 General Information
Name - Mamata

Age - 32 years

Gender - Female

Address - Mudipu Village, Bantwal Taluk, Dakshina Kannada

Occupation - Tailor

Religion - Hindu

Date of Admission - 6th February 2022

Date of Examination - 24th February 2022

Ward - ANC Ward 1

Total Family Income - 15,0000/month

Socioeconomic status - Upper Lower Class
Antenatal Care History
She is a primigravida

Last Menstrual Period = 18th June 2021

Expected date of delivery = 25th march 2022

Current period of gestation = 34 weeks

Antenatal Care History
First Trimester

Patient conceived spontaneously. It was confirmed by USG at 42 days (6 weeks).

She went for regular ANC check ups at a local clinic in Muddippu. She took regular
folic acid tablets. She was diagnosed with hypothyroidism and started on tablet
thyronorm 50 microgram, once daily before breakfast. She gave history of nausea
and vomiting which was followed after a missed period.

No history of fever with rashes, spotting per vagina, teratogen or radiation

exposure.
Antenatal Care History
Second trimester
Patient went for regular ANC check ups at local clinic in Muddippu.
Quickening felt in 5th month of pregnancy.
She took regular iron, folate and calcium tablets. Fetal heart sounds detected at 19th
week.
2 doses of Tetanus toxoid given.
Tablet thyronorm dose increased to 100 microgram.
USG sone at 5th month revealed no abnormalities. She doesn’t give history of bleeding
per vagina, hypertension, diabetes or anemia.
Antenatal Care History
Third trimester
The patient came to Lady Goschen Hospital, Mangalore with chief complaints of slight
bleeding per vagina which was bright red in color and painless. She soaked one pad
halfway. She also complained of nausea.
Iron and calcium tablets were regularly taken. Fetal movements were well appreciated.
No history of pedal edema, headache, blurred vision or elevated blood sugar.
She was diagnosed with grade 2 placenta previa which is anterior right lateral, lower
margin partially covering the internal os and retroplacental hematoma was seen in the
USG.
PAST HISTORY
No history of hypertension prior to pregnancy
No history of diabetes mellitus
No history of renal or cerebral disorders
No history of asthma, epilepsy or TB
No history of past surgeries
No history of blood transfusions
No history of drug allergies
OBSTETRIC HISTORY
Score : G1

This is patient’s first pregnancy.

She has not used oral contraceptive pills but used barrier methods like condoms
for 1 year.
MENSTRUAL HISTORY
She had regular cycles of 30 days with 3 to 4 days of bleeding.

No history of dysmenorrhoea or clots.

PERSONAL HISTORY
Consumes mixed diet

Has adequate sleep

Regular bowel and bladder habits

Has normal appetite

No history of drinking, smoking or chewing tobacco.

Diet history

Food item Quantity Calories(Kcal) Protein(g) Calcium(mg) Iron(mg) Vit A(mcg)

BREAKFAST

dosa 4 488 12.4 64 4.4 4

tea 1 cup 100 1.6 78 0.1 22

sambhar 1 katori 136 6.5 34 2 17

apple 1 59 0.6 10 0.6 -

Food item Quantity Calories(Kcal) Protein(g) Calcium(mg) Iron(mg) Vit A(mcg)

LUNCH

rice 1.5 cup 264.5 5.1 7.5 2.4 -

Boiled egg 1 78 6 27 0.9 230

Plain dal 1 katori 258 11.2 37 29 17

DINNER

rice 1 cup 176 3.4 5 1.6 -

dal 1 katori 258 11.2 37 29 17

TOTAL 1817.5 58 300.5 43.9 307

RDA 2480 60 1200 35 800

DEFICIT -662.5 -2 -899.5 +89 -493

Family and Social History
● Type of Family- Extended Family with 4 members
● Total Family Income- Rs. 15,000/month
● Per capita income- Rs. 3,750/person
● According to Modified Kuppuswamy Scale 2021
○ Education of head of family- 4
○ Occupation of head of family- 3
○ Monthly family income- 2
○ Total of 9
○ The family is in upper lower class
Family and Social History

Name Age Gender Relation to Education Occupation Income

Head

Ashok 35 years Male Head 10th Sports 10,000 rs

Shop
Owner

Mamata 32 years Female Wife PUC Tailor 5,000 rs

Vishwanath 65 years Male Father 5th - -

Varajakshi 55 years Female Mother 5th - -

Housing
● Type of House- Kutcha
● 3 Rooms
○ Separate Kitchen
○ No overcrowding
● 2 Bathrooms
● Lighting and Ventilation is adequate
○ 5 bulbs
● Waste Disposal- Municipal bin
● Source of fuel- LPG
● Water- Municipal water supply
● No factories nearby, no pets
● Local clinic nearby
Family chart

Mrs. Varajakshi Mr. Vishwanath

Mrs. Mamata Mr. Ashok

General Examination
Patient was conscious cooperative and of lean built.

Height - 160cm Weight - 45.7kg

Pallor - Absent

Icterus -Absent

Cyanosis -Absent

Clubbing -Absent

Lymphadenopathy -Absent

Edema- Absent
Vitals
Afebrile at time of examination

BP- 112/72 mm of Hg

RR- 16 cycles/min

Pulse - 82bpm

Breast, thyroid gland and spine appear clinically normal.

Systemic Examination

CVS - S1 S2 heard
RS - Normal vesicular breath sounds heard
CNS - No focal neurological deficit

INVESTIGATION

Hb - 11.2g/dl
Blood Group- A+ve
Urine Test - no albumin or sugar present
HbsAg - Negative
VDRL- Negative
TSH - 29.8
OBSTETRIC EXAMINATION

INSPECTION-

Abdomen is longitudinally distended. Linea nigra present. Umbilicus is central,

stretched. Flanks are full. No scar, or dilated veins.

PALPATION-

Abdomen is non tender.

Fundal Height corresponds to 34 weeks
Girth is 97cm
GRIPS
1. Fundal - Firm, Irregular,Ballotable
2. Lateral - Left - knob like structure of limbs
Right - smooth continuous contour shape suggestive of
spine
3. Pawlik’s - hard globular ballotable mass indicative of head
4. 2nd Pelvic Grip - Fetal head is not engaged.
5. Cephalic presentation, Longitudinal Lie

AUSCULTATION
Fetal heart sound heard between umbilicus and ilium on the right side.
Fetal heart rate is 126bpm
 REPORTS AVAILABLE
INVESTIGATIONS 20th Feb 2022 NORMAL VALUES
Hb 11.2 11.5-13.5g/dl

HbsAg Negative

VDRL N/R

PPTCT Negative

TSH 29.98 0.38-4.0mU/L

Albumin and Sugar Trace or Nil

*the reports available are of third trimester.

KAP analysis
Knowledge Attitude Practice

Personal hygiene Adequate Positive Good

Breastfeeding Not adequate Positive -

Complementary Not adequate Positive -

feeding

Iron and folic acid Adequate Positive Good

tablets

Diet Not adequate Positive Not good

Complications of Not adequate positive -

hypothyroidism

Government Not adequate positive -

schemes
MANAGEMENT:
Individual level:
Continue taking regular iron and folic acid tablets.
Increase calorie intake, by eating more cereals and pulses by increasing your rice intake or
increasing intake of pulses like in sambhar. Also increase iron intake by eating jaggery or fish and
increase vitamin intake by eating more bananas and other fruits and vegetables. Increase
calcium rich foods like milk in the evening or eat curd along with her meals. After delivery you will
also have to increase your food intake even more so you can produce enough milk for the baby.
Take rest and don’t do any heavy physical labour.
After birth solely breastfeed for 6 months, then start complementary feeding after that.
Take help and support from others.
MANAGEMENT:
Continue taking medicines for hypothyroidism, it’s safe for the baby and don’t stop
taking till the doctor says so, follow the doctor’s advice regarding how much to
take as the dose can be changed after delivery.

Come for regular checkups upto a year after delivery.

Immediately visit the doctor if you develop fever, slowness of breath, changed
mental status,or increased swelling of hands and feet as it could be an
emergency.
MANAGEMENT:
Family level:
Give emotional support.
Maintain proper hygiene around baby.
Give mother support in taking care of the baby.
Help her in taking all her medicines on time
If you see her with altered behaviour, mental status, swollen limbs, fever etc; then
immediately bring her to the hospital.
MANAGEMENT:
Community level:
Ensuring health of mother and child is monitored by availing schemes such as the JSSK.
Ensure institutional delivery by availing schemes such as the JSY.
Spread awareness on the importance of spacing, exclusive breastfeeding and
complementary feeding.
Inform on how to access iron and folate tablets such as under the Vandemataram
scheme where private hospitals can provide free iron and folate tablets and other
essential ANC services.
SUMMARY
A 32 year old Primigravida (G1) female from upper lower class came to Lady
Goshen Hospital on 6th Feb 2022 with chief complaints of bleeding per vagina
and nausea. She was was diagnosed with Grade 2 Placenta Previa which is
anterior right lateral, lower margin partially covering the os and retroplacental
hematoma which was seen in USG.She was also diagnosed with Hypothyrodism
in her first trimester for which she was given thyroxine tablets. Her current period
of Gestation is 34 weeks. There are no other complications present.
THANK YOU