OBG Cases-1 - 240402 - 092346

ROLL NO 1- CASE 1
(1) GDM
NAME-Mrs.ABC W/O XYZ DOA-29/5/2020
AGE-30 yrs DOE-29/5/2020
ADDRESS-Harihar
EDUCATION-8thstd
OCCUPATION-home maker
SOCIO- ECONOMIC STATUS- upper middle class
[modifiedkuppaswamy scale]
Primigravida with 7 months of amenorrhea , appreciating fetal movements well, is referred

from harihar i/v/o increased sugar levels
During her regular ANC in harihar hospital CBC and OGCT was done, OGCT was found to be
raised [OGCT- 168mg/dl], patient was started on Tab. metformin 500mg BD and was
referred for further management .
No c/o pain abdomen
No c/o bleeding per vagina/ leaking per vagina
No c/o burning micturition/ increased frequency of micturition
No c/o headache/ blurring of vision / epigastric pain
No c/o chestpain /palpitations/ easy fatigability
No c/o fever with chills/ cough/ cold
HISTORY OF PRESENT PREGNANCY
Patient conceived spontaneously in 2yrs of marriage. No contraceptives used. Pregnancy

diagnosed at 2 months of amenorrhea by UPT at PHC
1 TRIMISTER-Tab.folic acid taken .
No h/o hyperemesis gravidarum/bleeding or spotting pre vagina.
No h/o fever with rash and urinary disturbances.
2 TRIMISTER- quickening felt at 5 months of amenorrhea,

2 doses of TT Inj taken.
Tab Iron and Calcium taken
Anomaly scan -24 weeks of gestation – shows no abnormalities detected,

growth is adequate for gestation age.
No h/o bleeding per vagina/ pain abdomen / PIH symptoms
3 TRIMISTER – patient was diagnosed as GDM at 7 months of amenorrhea in harihar

hospital – OGCT was done and found to be raised , patient was started on Tab. Metformin
500mg BD and was reffered to higher centre for further management.
OBSTETRIC HISTORY
Married life- 2 yrs non –consanguineous marriage
Primigravida
MENSTRUAL HISTORY
Age of menarche-14 yrs
Previous menstrual cycle-3-4/30 days, regular, moderate flow, no clots ,

no dysmenorrhoea.
LMP-23/12/2019
EDD-30/9/2020
USG EDD[ 24 WKS]- 26/9/2020
PERIOD OF GESTATION- 31 WEEKS 6 DAYS
PAST HISTORY- No h/o blood transfusion
No h/o drug allergy
No h/o any surgery
Not a known case of – hypertension/ bronchial asthma/ tuberculosis/ epilepsy/ cardiac/

thyroid / renal disorders.
FAMILY HISTORY- mother is a K/C/O – type 2 DM- on oral hypoglycemic agents
PERSONAL HISTORY-
DIET- mixed
APPETITE- good
SLEEP- adequate
BOWEL AND BLADDER- regular.
GENERAL PHYSICAL EXAMINATION
A 30yr old patient moderately built and nourished, conscious, cooperative well oriented to
time place and person.
No -Pallor/ icterus/clubbing / cyanosis/ lymphadenopathy/ pedal edema.
ANTHRPOMETRY – HEIGHT- 150cm
PRE PREGNANCY WEIGHT- 60Kg BMI-26.6
PRESENT WEIGHT -72Kg
THYROID/ BREAST/ SPINE- CLINICALLY NORMAL
VITALS- TEMPERATURE-afebrile
BP- 136/84mmHg measured in sitting position
PULSE- 90bpm, regular rhythm, good- volume.
SYSTEMIC EXAMINATION-
CVS/RS- NAD
CNS- HMF NORMAL
PER ABDOMEN – uterus 28 week size
External ballottement present. FHS+ Regular 150-160bpm
INVESTIGATIONS
HB-10.9gm/dl
BG-B positive
TC-10,400cells/cumm
RBS-160mg/dl
HbA1C-7%
U/A-nil
RFT-wnl FBS-138mg/dl
ROLL NO 2- CASE 2
White discharge PV
Mrs X
35 years
Davangere
Occupation- Housemaker
SES: Lower middle case
Husband-40years, Farmer by occupation
CHIEF COMPLAINTS:
c/o discharge per vaginum since 1 month
HOPI:
Patient gives history of discharge per vaginum since 1 month, which is on and off type,
white in colour, associated with foul smelling and itching in the vulval area.
Patient is a known case of diabetes mellitus since 2 years, and on oral medications.
No h/o similar complaints in the past.
No h/o burning micturition, increased frequency of micturition.
No h/o dyspareunia / pain abdomen.
No h/o post coital bleeding/ mass per vaginum
No h/o evening rise of temperature, cough, chills and rigors.
OBSTETRIC HISTORY:
Married life- 17 years
P2L2
1st P= FTND / Male/ 16 years/ alive and healthy/ Home delivery
2nd P= FTND/ Female /13 years/ Alive and healthy/ Home delivery
Tubectomised 10 years back
MENSTUAL HISTORY:
AOM: 13years
LMP: 10/7/2020
PMC= 3-4/28-30 days, regular, moderate flow, No clos/dysmenorrheal
PAST HISTORY:
No h/o major surgeries in the past.
No h/o blood transfusions
No h/o drug allergies
She is known case of type 2 diabetes mellitus and on tab glimepiride
Not a known case of hypertension, brochial asthama, epilepsy, tuberculosis
SEXUAL HISTORY:
Single partner
No h/o of similar complaints in the partner
PERSONAL HISTORY:
Diet- Mixed
Sleep- Sound
Appetite- Adequate
Bowel and bladder- Normal and regular
Non alcoholic, non-smoker
GENERAL PHYSICAL EXAMINATION:
A middle aged lady who is moderately built and poorly nourished, conscious, co-operative
and well oriented to time, place and person
Vitals= Temp- 96.5 degree F
PR- 82 bpm, regular, normal volume
BP- 122/80 mmHg
Height- 158 cm
Weight- 40kg
BMI- 16kg/m sq.
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema

SYSTEMIC EXAMINATION:
CVS, RS, CNS= No abnormalities detected
PA-
Inspection:
Normal looking abdomen
Umbilicus is central and inverted
Tubectomy scar+ Healed by primary intension.
Corresponding quadrants move equally with respiration.
No other scars or engorged veins.
All hernia orifices appear intact.
Palpation:
Soft, non tender.
No organomegaly
Local examination of external genitalia:
Normal skin, pubic hair distribution, mons pubis
Vulva-Congested
Scratch marks are present over inner aspects of thigh and in labia major and minora
P/S- Cervix congested
Vagina- Curdy white discharge present which is adherent to vaginal wall.
BME- Cervix normal, Uterus A/V, Normal size, firm, mobile, B/L fornices free and non-
tender.
ROLL 3 CASE 3
APH
Name: XYZ
Age: 23 years
Address: W/O ABC, Challagere
Occupation: Housewife
SES: Lower middle socioeconomic class according to Modified Kuppuswamy Classification
She is G3P2L2 with 8½ calendar months of amenorrhoea, AFM well came with C/O Bleeding
PV since 2 hours prior to admission
HISTORY OF PRESENTING ILLNESS:

- Patient was apparently normal 2 hours back, then she noticed C/O Bleeding per
vaginum. She was at home and noticed this soon after waking up from bed and
sitting on a chair.
- She had a single episode of bleeding PV 2 hours prior to admission which was
sudden in onset, bright red in colour, moderate in amount (soaking her under
clothes and 1 pad). This episode lasted for a duration of 1 hour. Bleeding subsided
by itself before patient reached the surface
- No H/O passage of clots
- No C/O pain abdomen, leaking PV
- No H/O trauma, coitus, strenuous activity
- No H/O similar bleeding episodes in the past
- No H/O syncopal attack, generated weakness, easy fatigability
- No H/O headache, blurring of vision, epigastric pain
- No H/O fever, cough/travel history
HISTORY OF PRESENTING PREGNANCY:
She conceived spontaneously 2 ½ years after previous child birth. Diagnosed pregnancy at
2 MOA by BME and UPT at Devarahalli Government Hospital. Regular ANCs taken at
Nuggenahalli PHC
1st Trimester:
- No H/O excessive nausea/vomiting
- No H/O spotting PV/bleeding PV
- No H/O pain abdomen
- No H/Oincreased frequency of micturition
- No H/O drug intake/radiation exposure
- No H/O fever with rash
- Tab. Folic acid taken from diagnosis of pregnancy
2nd trimester :
- Quickening felt at 5MOA
- No H/O bleeding pv, pain abdomen
- Anomaly scan done at 5 MOA revealed low lying placenta and patient was advised
bed rest and to avoid strenuous activities.
- 2 doses inj TT taken at 4th MOA and 5th MOA.
- Tab.FS and Ca supplements taken regularly.
3rd trimester :
- She came with above complaints
OBSTETRIC HISTORY
- Married life : 7 years.
- Non consanguineous marriage
- G3P2L2
- 1P
- She conceived 1 yr after marriage. Regulus ANCs were taken
- FTVD of a female baby of weight 2.5 kg at Devarahalli Government hospital.
- No antepartum and intrapartum complications. She was discharged on PND3
.
- Baby was breast fed for 1 and half years. Attained milestones corresponding
to age. Well immunized
- 2P
- FTVD of female baby of weight 2.8 kg, 2years old @ Devarahalli Government
hospital
- No H/O contraceptive usage in the inter pregnancy interval
- 3P
- Present pregnancy
MENSTRUAL HISTORY
- AOM - 12 years
- LMP-15/9/2019
- EDD- 22/6/2020
- POG : 36 weeks+2 days
- PMCs 2-3 days/ 28-30days regular cycles, moderate flow, no clots/ dysmenorrhoea
PAST HISTORY
- Not a k/c/o HTN, DM, TB, Asthma or epilepsy
- Not a k/c/o cardiac, renal or thyroid disorders
- No H/O previous surgery, D&C No H/O blood transfusion
- No H/O drug allergy
FAMILY HISTORY
- Nothing significant
PERSONAL HISTORY
- Diet - Mixed
- Appetite - good
- Sleep - sound
- Bowel and bladder - regular and normal
- She is moderately built and nourished, cooperative
- Temperature: 93 F
- PR - 92 bpm, regular rate and rhythm, good volume measured in right Radial artery
- BP - 110/70 mmHg in sitting position
- Thyroid, B/L Breast and spine are clinically Normal
- Height - 150 cm
- Weight - 52 kg
- BMI - 23.1 kg per m2
- No pallor, cyanosis, clubbing,icterus or Lymphadenopathy
- No pedal edema
- CVS, RS, CNS - Clinically Normal
- PER ABDOMEN :
- Inspection:
- Abdomen is uniformly distended
- Umbilicus central and stretched Linea nigra and striae gravidarum are
present.
- Uterus appears 36 weeks size.
- No scars or dilated veins
- Hernial orifices appear intact.
- Palpation:
- Uterus 36 weeks size, relaxed longitudinal lie.
- SFH - 34cm AG- 94cm EFW - 3.4kg
- fundal grip - S/O breech
- Lateral grip-
- Right side S/O back
- Left side S/O limbs
- Pelvic grip-1
- S/O head lower pole, floating head
- Auscultation:
- FHS present, regular, 140-148 bpm, along the right spinoumbilical line
- Vulval examination:
- Moderately soaked pad seen
- No active bleeding
PROVISIONAL DIAGNOSIS:
G3P2L2 with 36 weeks 2 days of gestation with cephalic presentation with
Antepartum hemorrhage for further evaluation
ROLL NO 4- CASE 4
Primary amenorrhoea
Miss XYZ
15 years
2nd PUC
Chitradurga
Lower socio-economic status
CHIEF COMPLAINTS:
She was brought to OPD by her mother with H/O not attained menstrual cycles.
HOPI:
Not having attained menses.
No H/O cyclical abdominal pain, abdominal distension.
No H/O headache, seizures, vomiting, visual disturbances.
No H/O trauma to head.
No H/O difficulty in perception of smell.
No H/O abnormal weight loss/ weight gain.
No H/O excessive physical activity or competitive sports.
No H/O head/ cold intolerance, fatigue, lethargy
No H/O discharge from nipples.
No H/O abnormal or excessive hair growth, voice change.
MENSTRUAL HISTORY:
Not attained menarche
OBSTETRIC HISTORY:
Unmarried
PAST HISTORY:
No H/O tuberculosis
No H/O major surgeries in the past
Milestones of growth and development were normal.
Performance in school is satisfactory

FAMILY HISTORY:
Nothing significant.
PERSONAL HISTORY:
Diet-Veg
Appetite-Adequate
Sleep-Sound
Bowel and bladder- Normal and regular
A young female average built and nourished. Comfortable and co-operative at the time of
examination.
Ht-143cm – Short stature
Wt-37kg
BMI-18.13kg/m sq
Arm span- 142.5 cm
PR- 88bpm
BP- 100/60 mmHg
No pallor, icterus, cyanosis, edema, lymphadenopathy.
Thyroid- Clinically normal
Spine- Normal
Secondary Sexual Characteristics:
Breast- Tanner Stage 1, widely spaced nipples
Pubic hair- Tanner Stage 1
Systemic Examination:
CVS- S1 and S2 heard. No murmurs.
RS- B/L NVBS heard
CNS- Conscious, oriented
Hearing, olfactory system- Normaal

Sensory and motor examination- Normal
Abdominal examination:
Inspection:
- Umbilicus is central and inverted.

- Abdomen is scaphoid in shape.
- All quadrants move equally with respiration.
- No scars/ engorged veins
- All hernia orifices are free.
Palpation:
- Soft, non-tender.
- No organomegaly
Examination of external genitalia:
- Labia majora, Labia minora- appears underdeveloped.

- Clitoris- Normal.
- Pubic hair- Tanner stage 1
- Hymen- intact with a normal orifice.
Per rectal examination:
No mass felt anterior to rectum.
SUMMARY:
15 year old girl presented with not having attained menses, with no other complaints and
nil contributory medical and surgical history. On examination, was found to have short
stature with poorly developed secondary sexual characteristics and a intact hymen with
normal orifice.
Investigations:
FSH- Levels are high
Karyotype- 45 X0
Pelvic Scan- Uterus is normal with Streak ovaries

ROLL NO 5- CASE 5
Transverse lie
Name: XYZ
Age: 28 years
W/O ABC
Address: Bellary
Occupation: Housemaker
She is G3P2L2 with 9 calendar months of amenorrhoea, AFM well came for regular antenatal
check-up

She is 9 months of amenorrhoea, appreciating fetal movements well.
- No H/O bleeding PV
- No H/O generated weakness, easy fatigability
- No H/O burning micturition or increased frequency of micturition.
2 MOA by UPT and confirmed by scan at Hagaribommanahalli Government Hospital.
Regular ANCs taken at Kottur PHC.
1st Trimester:
- No H/O increased frequency of micturition
2nd trimester :
- No H/O bleeding PV, pain abdomen
- Anomaly scan done at 5 MOA and told to be normal.
- Tab.FS and Ca supplements taken regularly.
3rd trimester :
- She came for regular ANC.
OBSTETRIC HISTORY
- Married life : 7 years.
- G3P2L2
- 1P
- She conceived 1 yr after marriage. Regular ANCs were taken
- FTVD of a male baby of weight 2.5 kg at Hagaribommanahalli Government
hospital.
.
- Baby was breastfed for 1 and half years. Attained milestones corresponding
- 2P
- FTVD of female baby of weight 2.8 kg, 2years old at Nagenahalli Government
hospital
- 3P
- Present pregnancy
MENSTRUAL HISTORY
- AOM - 12 years
- LMP-15/12/2019
- EDD- 22/9/2020
- POG : 36 weeks+2 days
PAST HISTORY
- Not a k/c/o HTN, DM, TB , Asthma or epilepsy
- No H/O previous surgery, No H/O blood transfusion
FAMILY HISTORY
PERSONAL HISTORY
- Diet - Mixed
- Appetite - good
- Sleep - sound
- Temperature: 93 F
- PR - 92 bpm,
- BP - 110/70 mmHg
- Height - 150 cm
- Weight - 52 kg
- No pallor, cyanosis, clubbing, icterus, edema or lymphadenopathy
- PER ABDOMEN :
- Inspection:
- Abdomen is wide, looks broader and oval transversely but shorter
vertically.
- Umbilicus central and stretched.
- Linea nigra and striae gravidarum are present.
- Palpation:
- Uterus 32 weeks size, Relaxed.
- Transverse lie.
- SFH - 30cm AG- 110cm
- Fundal grip – No fetal pole is palpable
- Lateral grip-
- Right side S/O fetal head (R iliac fossa)
- Left side S/O Breech
- Pelvic grip-1
- It is empty.
- Auscultation:
- FHS present, regular, 140-148 bpm, below the level of umbilicus
G3P2L2 with 36 weeks 2 days of gestation with transverse lie for further management.
ROLL NO 6-CASE 6
Postmenopausal bleedding
Mrs ABC
W/O XYZ
Age- 48 Years
Taralabalu
Lower middle class
CHIEF COMPAINTS:
Spotting per vaginum on and off since 4 months
Abdominal bloating since 2 months
HOPI:
Patient was apparently alright 4 months back, then she had spotting PV, on and off since 4
months, scanty amount, altered blood, not associated with passage of clots or foul smelling
discharge. Stops on itself. No associated pain abdomen.
Patient also C/O dyspepsia- 2 months. H/O early satiety. She consulted a local gynecologist
for the same a month back and was found to have a pelvic mass on ultrasound. Hence
referred for further evaluation and management.
- No H/O abdominal distension, pain abdomen

- No H/O bowel or bladder disturbances.
- No H/O loss of appetite or loss of weight
- No H/O postcoital bleed.
- No H/O mass descending PV
- No H/O breathlessness, leg swelling, jaundice, bone pain
- No H/O hormonal replacement therapy.
- No H/O irradiation or past history of malignancy.
MENSTRUAL HISTORY:
AOM- 13 year
PMC- Regular, moderate flow. No clots, dysmenorrhoea
Attained menopause at 45yrs.

OBSTERIC HISTORY:
ML- 28 years
P2L2
Concieved spontaneously.
Both FTND- uneventful.
No H/O oral contraceptive use or hormonal implants.
No H/O treatment for infertility.
PAST HISTORY:
-H/O spotting PV 1 year back, for which she didn’t seek any medical advice.
- No H/O diabetes, hypertension, cardiac, seizure disease, bronchial asthma, malignancies.
- No H/O previous surgeries or irradiation.
- No H/O hormone replacement therapy.
FAMILY HISORY:
No H/O breast, GI or ovarian malignancies in family.
PERSONAL HISTORY:
- Consumes non-vegetarian diet.

- Appetite normal.
- Sleep- Sound
- Bowel and bladder- Normal and Regular
Patient comfortable, obese
No pallor, icterus, cyanosis, clubbing, pedal edema, no lymphadenopathy.
Thyroid, Breast, Spine- Clinically normal.
No supraclavicular lymphadenopathy
Performance score-1
BP- 130/80 mmHg, PR- 82/min, RR- 14/min, Temp- 98.8F
Height- 151cm, Weight- 69kg, BMI- 30.2kg/cm sq

RS- NVBS heard. No added sounds.
CVS- S1 and S2 heard. No murmurs.
CNS- No focal neurological deficit. Higher mental fuctions normal.
Abdominal Examination:
Inspection-
- Abdomen distended below umbilicus.

- Umbilicus central and inverted.
- All quadrants move equally with respiration.
- No dilated veins, scars, pulsations and peristalsis.
- Hernial orifice- free.
Palpation:
- A solid cystic mass 15*10 cm felt in the lower abdomen occupying

hypogastrium, right iliac, right lumbar and umbilical regions.
- Margins irregular
- Bosselated surface.
- Mobility restricted. Non-tender, lower border is not palpable. No free fluid.
- No inguinal lymphadenopathy.
Percussion:
- Dullness made over the mass area. Rest of the abdomen- normal. No shifting
dullness.
External genitalia:
Normal
Per Speculum:
- Vagina appears pale, atrophic with minimal rugosity

- Cervix healthy, central in position
- No gross lesions or abnormal discharge.
Bimanual Examination:
- Cervix feels healthy.

- Uterus retroverted. Exact size couldn’t be assessed.
- 20 weeks uterine size solid cystic mass felt through the anterior, posterior
and right fornices, filling the pelvis. No transmitted mobility.
Per rectal Examination:
Rectovaginal septum intact. No nodularity in POD. Rectal mucosa free.
Provisional Diagnosis:
48 years P1L1, post menopausal with ovarian mass, most probably malignant.
ROLL NO 7- CASE 7
Rh Negative Pregnancy
Name : abc
W/o :xyx
Age :28
Address :Old Bethur Road, Davangere
SES :lower middle class according to modified kuppuswamy classification.
Booked case
G3P1L1A1 with 9 MOA,appreciatingfoetal movements well came with
complaints of pain abdomen since 1 day,insidious in onset,spasmodictype,radiating to tigh

and back,progressively increasing in intensity,not relieved with rest,enema,analgesics.
c/o leaking pv since 2 hrs .
no c/o headache,blurring of vision and epigastric pain.No c/o chestpainpalpitations,

easyfatiguabilty.
No c/o burning micturition ,increased frequency of micturition.
HOPI: Patient conceived spontaneously after 6 months after last abortion.
Pregnancy diagnosed by UPT and confirmed by BME.
Regular ANC taken at Govt hospital.
Inj TT 2 doses taken at 4 MOA and 7 MOA.
1st trimester: no h/o excessive vomiting/fever /burning micturition/
no h/o spotting pv/pain abdomen/drug or radiation exposure.
Tab. Folic acid taken regularly. Routine investigations done and blood is found to be B
negative.
2ndtrimester: Quickening felt at 5MOA.
No c/0 pain abdomen,bleeding PV,
ICT was done and it was negative.

Tab iron and calcium taken.
Anomaly scan was done and found to be normal.
3rd trimester: came with above complaints.
Obstetric History:
ML:3 yrs, NCM
G3P1L1A1.
P1:FTVD/male/2.7 kg/alive and healthy/Govt hospital/.
No antepartum or intra partum complications/Inj.Anti-D administered on day 2 of post

natal period.
P2: Spontaneous abortion at 2MOA.complete abortion(anti d not given)
P3: Present pregnancy.
Menstrual History:
AOM:14 YRS
LMP:16/9/2019
EDD:23/6/2020
POG:38 +6
PMC:3-4/30 days, regular, moderate flow, no clots, no dysmenorrhea.
Past h/o:
No history of blood transfusion.
No h/o surgeries in the past.
No h/o drug allergy.
MEDICAL HISTORY:
Not a k/c/o DM/Hypertension/Epilepsy/thyroid/ cardiac/renal disease/asthma.
PERSONAL H/O:
Diet –mixed,
Appetite- good,
Sleep –adequate,
Bowel and bladder – Normal and regular.
General Physical Examination:
Here is a patient who is moderately built and nourished, oriented to time place and person
.
Thyroid - Normal
Spine -Normal
Breast-Normal
Pallor -Absent
Icterus-Absent
Cyanosis-Absent
Clubbing-Absent
Lymphadenopathy-Absent
General condition :fair/afebrile
CVS/RS: NAD
Per Abdomen:
INSPECTION:
Abdomen uniformly distended.
Umbilicus central and everted.
Stria gravidarum present
No scars /sinuse/dilated veins/hernia orifices intact/no visible pulsations/
PALPATION:
Uterus term size, acting and relaxing(4c/35-40 sec)
Fundal grip suggestive of breech.
Lateral grip –right-s/o back
- left-s/o limbs
1st pelvic grip-s/o head ,2/5th palpable
2nd pelvic grip-engaged
AUSCULTATION:
FHS + Regular 140-150 bpm
Per vaginum : Cervix soft, central, 75% effaced, 3 cm dilated ,membranes absent, clear leak
+. Vertex at 0 station.
Pelvis adequate ,No CPD
ROLL NO 8- CASE 8
Infertility
Name- Mrs. XYZ
Age- 30yrs
Address- Davangere
Education- 4th Std
Homemaker
w/o Mr. YAge- 32 yr
Fruit seller by occupation
Belonging to lower middle class as per modified Kuppuswamy scale
CHIEF COMPLAINTS:
Inability to conceive since 4 years of active married life
HOPI:
She is married for 4 years and staying together with coital frequency of 2-3 times a week.
No coital difficulties and use of lubricants/ jellies. She has irregular cycles since 2 years
No h/s/o dysmenorrhoea, heavy menstrual bleeding, dyspareunia.
No h/o any abnormal discharge per vaginum
No h/o any discharge from the breast
No h/o any excessive hair on face or body or acne

No h/o cold intolerance, fatigue, constipation
No h/o fever or cough
MENSTRUAL HISTORY:
AOM: 12 years
LMP: 17.07.2019
Irregular cycles: 3-4/ 40-60 days , moderate flow, no clots , no dysmenorrhoea
OBSTETRIC HISTORY:
ML - 4 yrs NCM
Nulligravida
PAST HISTORY:
No h/o any surgeries
No h/o drug intake
No h/o chronic diseases- TB, DM, hypertension, thyroid disorders.
No h/o sexually transmitted diseases
PERSONAL HISTORY:
No h/o smoking, alcohol consumption, tobacco use
Mixed diet, Appetite normal
Sleep adequate
Bowel and bladder habits regular
FAMILY HISTORY:
No h/o early menopause or infertility
MALE FACTORS:
No h/o smoking, alcoholism, any substance abuse
No h/s/o premature ejaculation, erectile dysfunction
No h/o any surgeries in the past
No h/o mumps in childhood or recurrent chest infections, DM, TB, STI
No h/o urethral discharge or urinary complaints

No h/o trauma to genitalia
Moderately built and nourished
Height- 150cm; Weight- 62 kg BMI- 27.55 kg/m2
Afebrile BP- 126/82 mm Hg , PR- 86 beats per min
No pallor, icterus, clubbing, lymphadenopathy, edema, lymphadenopathy
Breast – normal, no galactorrhoea;
Thyroid- Clinically normal
No hirsutism, acne , acanthosis nigricans
CNS : Clinically normal
CVS : S1, S2 heard, no murmurs
RS :NVBS+, no added sounds
PER ABDOMEN:
Inspection: Abdominal obesity+. Umbilicus normal in position, inverted. All quadrants

move equally with respiration. Hernial orifices normal
Palpation: Abdominal obesity+. Soft, non-tender, no organomegaly
GYNECOLOGICAL EXAMINATION-
External genitalia- Pubic hair distribution normal. Normal vulval pad of fat. Labia majora
and minora appears normal. No h/s/o chronic infection. Hymenal opening normal
P/S : Cervix, vagina healthy
BME : Uterus normal size, anteverted, mobile, b/l fornices free, non tender
ROLL NO 9 – CASE 9
Breech Presentation
Mrs XY
W/O Mrs AB
Resident of DV layout Davanagere
Belonging to upper lower middle class socioeconomic status according to modified

kuppuswamy classification
Admitted to CG hospital on 07/06/2020 at 3 pm
She is primigravida with 8 months of amenorrhea
Appreciating fetal movements well ,
Came for regular ANC
Histroy of presenting illness :
Patient has come for regular weekly antenatal check up
No history of pain abdomen
No history of leaking PV
No history of fever /cold/cough
No history of blurring of vision /headache/ vomiting /epigastric pain
No history burning maturation or increased frequency of maturation
Patient conceived 3 months after marriage , pregnancy confirmed at 2 months of

amenorrhea by bimanual examination and UPT at CG hospital .
1sttrimester :
No history of excessive vomiting/nausea
No history of spotting pv/bleedingpv
No history of drug intake or exposure to radiation
No history of fever with rash
Scan done at 3 months of amenorrhea – told to be normal

Folic acid supplementation taken
2ndtrimester :
Quickening felt at 5 months of amenorrhea
No history of bleeding PV/pain abdomen
No history of headache / blurring of vision /epigastric pain /vomiting
Anomaly scan done told to be normal
2 doses of Inj T.T taken at 4 & 5 months of amenorrhea
3rdtrimester :
Came for regular antenatal check up
OBSTETRIC HISTORY :
Married life : 1 year , Non consanguineous marriage
1P : Present pregnancy
She conceived spontaneously 3 months after marriage
No history of contraceptive usage
Menstrual history :
Age of menarche :13 years
Last menstrual period : 27/ 12 /2019
Expected dateof delivery : 03/10/2020
10 weeks USG EDD :09/10/2020
Period of gestation :34 weeks
Previous menstrual cycle :
3-4 days cycles regular , 28-30 days moderate flow ,No clots /No dysmenorrhea
PAST HISTORY :
No history of blood transfusion
No history of drug allergy
No history of previous surgery

FAMILY HISTORY :
No history hypertension ,diabetes ,asthma ,cardiac or renal disease
PERSONAL HISTORY :
Diet : Mixed
Appetite : Good
Sleep : Sound
Bowel and Bladder : Normal and regular
GENERAL PHYSICAL EXAMINATION :
Patient is moderately built,moderately nourished, well oriented to time , place and person .
She is conscious and co-operative
General condition : fair
Temperature ; 98^F
Pulse : 90 bpm, regular ,good volume ,measured in right radial artery
Blood pressure :110/70 mm of Hg
No Pedal edema
No pallor ,icterus ,cyanosis ,clubbing ,lymphadenopathy
Thyroid : clinically normal
Bilateral breast : clinically normal
Spine : clinically normal
Height :149 Cm
Weight :57 Kg
Body mass index :25.67 kg/m2
SYSTEMIC EXAMINATION
CVS : S1 S2 heard , No murmurs
RS ; Bilateral Normal vesicular breath sounds heard , No added sounds

CNS :No focal neural deficit
PER ABDOMEN :
Inspection : Abdomen is uniformly distended
Umbilicus is central and stretched
Linea Nigra present
Striae gravidarum present
No scars / sinuses
Hernia orifices appear intact
Palpation :Uterus 34 week size ,relaxed
Fundal grip : Hard ballotable mass felt below right hypochondrium suggestive of head
Right lateral grip : knob like structures suggestive of limb buds
Left lateral grip : uniformly curved resistance felt suggestive of back
Pelvic grip : soft broad irregular, non ballotable mass felt suggestive of breech
Auscultation :Fetal heart sound regular /140-150 bpm at the level of umbilicus
Diagnosis :Primigravida with 34weeks of gestation with breech presentation

IUGR
NAME - ABC
AGE: 22 YEARS
EDUCATIONAL QUALIFICATION:SSLC PASSED
HOME MAKER
W/O MR XYZ AGED 28 YEARS
OCCUPATION:SHOPKEEPER
MONTHLY INCOME:19000
SOCIO ECONOMIC STATUS :LOWER MIDDLE (MODIFIED KUPPUSWAMY’S

CLASSIFICATION)
PLACE:CHANNAGIRI
DOA:03-07-2020
CHIEF COMPLAINTS:
Patient has been referred to our hospital in v/o high blood pressure recordings from past 1
week(140/90-150/100) and the growth of the fetus is less for which it might need
neonatal icu care.she was started on medication for high bp recordings from 3 days.
HISTORY OF PRESENT PREGNANCY:
-perceiving fetal movements well.
-history of swelling of lower limbs noticed from past 15 days,not releving on rest or in
supine position.
-no h/o head ache,blurring of vision,epigastric pain,vomiting,decreased urine output
-no h/o pain abdomen,bleeding per vagina,leak per vagina
I TRIMESTER:
Pregnancy diagnosed at 2 months of amenorrhea by urine pregnancy test and confirmed

by trans vaginal sonography. She is a booked case at private hospital davanagere where
she had her regular ante natal check ups.
Taken folic acid tablets regularly
No history of excessive vomiting,spotting per vagina,dysuria,fever with rash
No history of any other drug intake or radiation exposure.
Blood tests done were told to be normal
Scan done was told to be normal
II TRIMESTER:
• Quickening felt at 5 months of amenorrhea
• 1 dose tt taken at 4 months of amenorrhea
• Iron and calcium supplements were taken regularly
• no h/o increased blood pressure recordings,pain abdomen,leak per vagina,

bleeding per vagina
• Scan and blood investigations were done which are told to be normal
• Patient was diagnosed to have hypothyroidism during 6th month of amenorrhea and
was started on tablet thyronorm 75 µg od
III TRIMESTER:
• At 7 moa,on routine ante natal examiation she was told that growth of fetus is less
and advised for a scan,however scan done and told that the fetal growth is less and
advised her to take proper nutrition
• Now patient has been referred to our hospital in v/o above complaints
OBSTETRIC HISTORY:
• Married life-2 yrs,non consanguineous marriage
• Gravida 2 abortion 1
• I pregnancy:spontanoeus abortion at 3 months of amenorrhea,check curettage not

done ,11 months ago
• II pregnancy:present pregnancy
MENSTRUAL HISTORY:
• Age at menarche:13 years
• Past menstrual cycles:3-4 days for every 28-30 days,changes 3 pads per day,no h/o
passage of clots or dysmenorrhea.
• No h/o usage of oral contraceptive pills.

• Last mestrual period : 08-12-2019
• Expected date of delivery : 15-09-2020
• Period of gestation(calculated)on the day of admission:38 week 2 days
Medical history:
• k/c/o hypothyroidism since 6 moa and is on medication (Tab.Thyronorm 75µg OD).
• Diagnosed to have hypertension during 9 MOA and started on tablet Labetelol

100mg bd since past 3 days).
• Not a k/c/o bronchial asthma, cardiac illness,renal disease,seizure disorder.
Past and surgical history:
 No h/o any major surgeries in the past
• No h/o blood transfusion or iron sucrose transfusion.
• No h/omalaria and tubeculosis.
FAMILY HISTORY:
• No h/o htn,type 2 dm,cardiac illness,tuberculosis or constitutionally small babies in

the family.
PERSONAL HISORY:
• Diet:mixed
• Appetite: normal
• Sleep: adequate
• bowel and bladder:regular
• Diet :
• • •
REQUIRE IN
D T
A
K
E
• CALORIE( • 2175 •
KCAL/DAY) 1
8
0
0
• PROTEIN( • 65 •
GMS/DAY) 5
2
• NO H/O ALCOHOL,TOBACCO OR SUBSTANCE ABUSE.
Young mother,moderately built and nourished,alert and oriented to time, place and person.
• Height- 154 cms
• Weight(pre pregnancy)-54 kg,62 kg(present weight)
• Bmi: 22.78 kg/m²
• Pulse rate: 78 bpm
• Blood pressure: 160/100 mm hg measured in the right arm in the left

lateral position
• Deep tendon reflexes: normal
• Bilateral lower limbs : grade ii pitting edema present
• No pallor,icterus,cyanosis,clubbing,lymphadenopathy
• Thyroid,breast and spine-clinically normal
• Urine albumin-loaded
Systemic examination:
• CNS: No focal and neurological deficits
• CVS: S1, S2 heard, no murmurs
• RS: Bilateral normal vesicular breath sounds heard. No added sounds
Per abdomen:
Inspection:
Abdomen is uniformly distended
Abdominal wall edema present

Umbilicus is central and everted
Linea nigra present.no striae gravdarum
All hernial orifices appears normal.
Palpation:
Uterus corresponds to 28 weeks size,relaxed
Symphysio fundal height : 28 cms
Abdominal girth:82 cms
Estimated fetal weight: 2480 grms
Liquor:clinically normal
Fundal grip:soft,irregular,non ballotable structure suggestive of breech
Lateral grip- right side: knob like structures felt suggestive of fetal limbs
Left side-smooth curved structure suggestive of fetal back
I pelvic grip:hard globular ballotable structure s/o head,mobile
Auscultation:
Fetal heart sounds-150 beats per minute heard along the spino umbilical line on the left
side.
Per vagina:
Cervix soft, posterior , uneffaced,os closed
Summary:
22 yr old G2 A1 with 38 week 2 days gestation referred here in v/o high blood pressure
recordings and reduced fetal growth.patient is diagnosed to have hypothyroidism during 6
moa and hypertension during 9 MOA and started on respective medications.
• On examination-blood pressure is 160/100 and bilateral grade 2 pedal edema.
• On per abdomen examination-uterus corresponds to 28 weeks gestation with fetus

in longitudinal lie and cephalic presentation with regular fetal heart sounds
• On per vaginal exn:cervix central,uneffaced,os closed.
Diagnosis:
22 yr old G2A1 with 38 week2 days gestation with cephalic presentation with intra uterine
growth restriction with severe pre eclampsia with k/c/o hypothyroidism and not in labour
 18/1/20 scan - 8 wks usg showing SLIUG
 26/2/20 scan – SLIUG with good cardiac activity and fetal movements
corresponding to 17 wk 5 day gestation,25 wk 5 days scan showing SLIUG
corresponding to 25 wk 2 days with good cardiac activity with no anomalies ,EFW
according to BPD,HC,AC,FL,811 +/- 118gm ,uterine artery PI -1.4 raised
 Scan done on 3/7/20 showing Cephalic presentation, placenta fundal posterior
grade 3 maturity ,AFI- 8cm, BPD -8.42cm ,33.6 wk, HC- 30.73,34.2 wk ,AC- 25.52,29.
5 wk , FL- 6.16,32wk
EFW- 1716+/-251gm (9th centile)
SLIUG corresponding to 32wk 3 days +/-3 wk with IUGR and normal liquor,
UA DOPPLER PI- 3.4
BPP- 6/8
ROLL NO 11- CASE 11
Mass PA
Name- Mrs XYZ
Age-35yrs
Illiterate
Occupation- Home maker DOA- 26/6/2020
SES- Lower middle class
Chief complaints:c/o Fullness in the lower abdomen since 2 months
c/o Pain abdomen since 2 months
HOPI:
Patient was apparently alright 2 months back, when she noticed fullness in the lower
abdomen, which was insidious in onset, gradually increasing in size, associated with pain
abdomen.
Patient also complains of pain abdomen, which is insidious in onset, confined to lower
abdomen, continuous dull aching type, non-radiating, not causing discomfort while doing
her household work and relieved on taking medication .
No h/o fever and vomiting. No h/o menstrual abnormalities. No h/o abnormal discharge PV
. No h/o evening rise of temperature, cough or fever with chills. No h/o bowel and bladder
disturbances. No relation of pain with food habits. No h/o breathlessness, generalized
weakness or easy fatigability. No h/o dyspareunia. No h/o loss of weight or appetite.
Menstrual History: AOM- 13 years
LMP- 6/6/2020 20days back
PMC= 3-4/ 28-30 days ; Regular, Moderate flow, Changes 3 moderately soaked cloth pads
per day, No clots or dysmenorrhea.
Obstetric History: ML- 20 years NCM P3L3
38 P- FTVD/ Female / 17years/ Alive and healthy/ WCH

38P- FTVD/ Male/ 15years / Alive and healthy/ WCH
3939P- FTVD/ Male/ 13years / Alive and healthy/ WCH
No intrapartum or postpartum complications. All children were breastfed for 2 years and
immunized upto date. Underwent abdominal bilateral tubectomy 13 years back.
Past History:
No h/o diabetes mellitus, hypertension, bronchial asthama, tuberculosis, epilepsy. No

cardiac, renal or thyroid disorders. No h/o other major surgeries in the past. No h/o
previous blood transfusion or allergy to any drugs.
Family History:
No history suggestive of breast, ovarian or GI cancers in the family.
Personal History:
Diet- Veg Appetite- Good
Sleep- Adequate Bowel and bladder- Normal and regular
Patient is non alcoholic and non smoker. No h/o drug abuse.
Patient is moderately built and moderately nourished, conscious, co-operative, well

oriented to time, place and person.
No pallor, icterus, cyanosis, clubbing, edema or lymphadenopathy.
Thyroid, Breast and Spine- Clinically normal.
Ht- 152cm Wt- 60 kg BMI- 25.96kg/m sq
Vitals- Patient is afebrile, PR- 88bpm; BP- 128/70mmHg; RR- 14cpm
Systemic Examination:
CVS- S1 S2 heard. No murmurs.
RS- Bilateral NVBS heard. No added sounds.
PA-
INSPECTION-
Lower abdominal fullness present. Umbilicus is inverted. Tubectomy scar+ healthy, linea
albicans present I the lower abdomen. No other visible pulsations or peristalsis. No other
scars or engorged veins. All hernia orifices appear intact.
PALPATION-
A solitary smooth lateral mass of about 10*10 cm which is located in hypogastric region,
extending to Right iliac, Right lumbar and umbilical region. Superior and lateral borders are
well made out. Lower border not made out. Mass is cystic in consistency. Mobile
horizontally. Non-tender. No evidence of hepatospleenomegaly.
PERCUSSION-
Dull note over the mass. Tympanic note elsewhere.
GYNECOLOGICAL EXAMINATION-
External genitalia- Pubic hair distribution normal. Normal vulval pad of fat. Labia majora
and minora appears normal.
P/S- Cervix directed upwards and forwards. Cervix and vagina- healthy
BME- Cervix firm, directed upwards and forwards. Uterus is retroverted, normal size,
deviated to left, firm, mobility restricted. Posterior and left fornix normal and non-tender.
Right and anterior fornix fullness present. Mass of about 10*10 cm which is separate from
the uterus is present in right iliac fossa. Cystic in consistency. Non-tender. Lower border
could not be made out. No cervical motion tenderness.
PR- Rectal mucosa free. No nodularities felt.
PROVISIONAL DIAGNOSIS- Right sided ovarian benign tumor for further evaluation
INVESTIGATIONS-
Hb= 10.3gm% TC= 13,470cells/cumm PC= 2.45lakhs
RBS= 121mg/dl LFT, RFT= Normal CA-125 = 19U/ml
USG Abdomen & Pelvis= Large well defined cystic lesion measuring 13*7*10 cm arising
from right adnexa containing no solid components. Right ovarian serous cystadenoma. No
free fluid/ omental thickening. Left ovary and uterus Normal.
ROLL NO 12- CASE 12
Twin Gestation
Name - xyz
Age. –32 years
Address - Malebennur
Education – 7th standard
Occupation - homemaker
SES–class 3 according to modified Kuppuswamy classification
Chief complaints-
C/o bilateral lower limb swelling since 2 months
C/o pain abdomen since 1 day
C/o bilateral lower limb swelling which is insidious in onset , extending till thigh relives to
some extent on taking rest
C/o pain abdomen which is sudden in onset intermittent, gradually increasing , spasmodic
type ,present in lower abdomen and radiating to back a/etightness of abdomen . Not
relieved on rest and no aggravating factor.
No history of leaking pv
No history of bleeding pv
No h/o headache /blurring of vision /epigastric pain or decreased urine output.
No history of burning micturation / increased frequency of micturation / fever with chills
No history of easy fatiguability / dyspnoea / orthopnoea /palpitations /facial puffiness

/periorbital edema/chest pain
No history icterus / easy bruising / bleeding tenderness
Not on any medication except iron , frolic acid and calcium

HISTORY OF PRESENT PREGNANCY-
1st trimester-conceived after 3 year of last child birth
 No contraceptive measures taken

 Confirmed pregnancy at 2 months of amenorrhea by UPT test at
Mallebennur PHC
 T folic acid taken
 No history of hyperemissis
 No history of bleeding pv
 No history of fever with rashes
 No history of urinary disturbances
 Scan done on 12 +1 weeks of gestation shown to be twin gestation
 No abnormalities/ complications was explained
 No history of double marker test
2nd trimester– quickening felt at 4 months ofamenorrhea
 2nd dose of TT taken

 T. Iron T calcium taken
 Anamoly scan done at 20 weeks of gestation said to be normal
 No history of bleeding pv
 No history pain abdomen
 No history of blurring of vision /epigastric pain / vomiting
 Had complaints of easy fatiguability
 Complains of bilateral lower limb swelling which used to relive on taking rest
3rd trimester - Appreciating feral movements well
 Scan done at 30+3 weeks if gestation no abnormalities said to be

normal .
 Now she comes with above complaints
OBSTETRIC HISTORY
Married life -7 years NCM
1st pregnancy–FTVD / female/2.2kg /active and healthy/at CGH/6 years ago
Conceived spontaneously after 1 year of married life and had taken regular ANC’s. No
antepartum/intrapartum/postpartum complication
2nd pregnancy - FTVD/female/2.9kg/active and healthy/@wch 3 years back.No history of
contraception after 1stchild birth
No intrapartum /postpartum complications
She didn’t give concern for IUCD insertion.
3rd Pregnancy-Present pregnancy
Conceived after three years after last child birth.
Menstrual history-
AOM –13 years
Past menstrual cycle –3/30 days cycle regular, moderate flow ,no clots , no dysmenorrhea
LMP- 04/09/2019
EDD –11/06/20
12+1 weeks usgedd– 14/06/20
POG – 36weeks as per 13/05/2020
PAST HISTORY –
No history of major surgeries
No history of HTN/t2DM/asthma/TB/RHD/epilepsy/thyroid /renal disorders.
FAMILY HISTORY- She herself was a twin at birth

No history HTN/DM/or any familial disorders
PERSONAL HISTORY
 Diet - mixed
 Appetite – altered.
 Sleep –disturbed , she prefers to sleep on left lateral side
 Bowel and bladder –regular and normal
General Physical Examination-
A 32 year old female moderately built , nourished, conscious , cooperative and oriented to
time place and person.
 Pallor present
 Bilateral pedal edema present , grade 2 ,pitting type
 No icterus , cyanosis , clubbing , lymphadenopathy
Anthropometry :
Height – 152 com
Weight –57 kg pre pregnancy weight
68kg at present
BMI –22.83 kg / metre square
Breast - Appear clinically normal
Thyroid Appear clinically normal
Spine - Appear clinically normal
Vitals – Afebrile
Bp –120/80mmhg measured in left arm sitting position
PR –92bpm regular in rhythm, good volume, no radio-radio delay , radio-femoral

delay
Systemic Examination–
Cardiovascular system- no murmurs
Respiratory system –bilateral normal vesicular breath sounds heard , no added sounds
Central nervous system- clinically normal
Per abdomen -
Inspection -
 Abdomen looks uniformly distended

 Umbilical central flattened , stretched transversely
 Linea nigra present
 Striae gravidarum present
 No dilated veins / scars / sinuses
Palpation-
 Uterus 36 weeks size , flanks full with 3 contractions lasting for 15 -20seconds/10
min
 Symphisiofundalheight – 36 weeks
 Abdominal girth – 102 cm
 Fundal grip –head felt in right hypochondrium
Breech felt in left hypocondrium
 Lateral grip – multiple feral parts felt
 1st pelvic grip head felt 5/5thpalpable
Auscultation-
FHS1 present/ regular / 136 bpm/ at left spinolateral line

FHS2 present / regular / 148bpm at just above umbilicals
PS - Candidiasis
Pv – not done
Summary-
A 32 year old G3PL2 with 36 weeks of gestation with 1st twin by cephalic presentation with
preterm labour
ROLL NO 13- CASE 13
Ca Cervix
PATIENT NAME:ABC
W/0: XYZ
AGE:55yrs
ADDRESS:Honnallitaluk,Davangere
IP NO-2014201
Belongs to class 3 modified Kuppuswamy socioeconomic status.
CHIEF COMPLAINTS: complaints of spotting per vagina since 1 week.
HISTORY OF PRESENTING ILLNESS: A 55 year old post-menopausal women, who was

apparently alright 7 days back, came with complaints of spotting per vagina, which was
around 5-10ml per day, watery in consistency. Last day she had bout of bleeding for about
10min (50-100ml) at once and stopped on its own,not associated with passage of clots, Not
associated with pain abdomen
She also complaints of loss of appetite and loss of weight since 6 months.
No history of chest pain, breathlessness, palpitations
No history of mass per abdomen
No history of white discharge per vagina
No history of burning micturition. Or increased frequency of micturition, or hematuria
No history of difficulty in passing stools
No history of mass per vagina
No history of low back ache
No history of pedal edema
MENSTRUAL HISTORY:
Age of amennorhea- 13 years
Past menstrual cycles- 4-5/30 days cycle, regular, no clots or dysmenorrhea.
Attained menopause 12 years back

OBSTETRIC HISTORY:
Married life- 36years, 2nd degree consanguineous marriage
Husband farmer by occupation, died 25 years back in accident.
P2L1, both FTVD
1st pregnancy- FTV D/male/ / home delivery/ died after 1 week of birth/cause of death not
known
2nd pregnancy- FTVD/ female/ 32years/ alive and healthy/ delivered at Honnalli hospital.
Tubectomized 31 years back
No history of HRT consumption
PAST HISTORY:
No history of previous major surgeries
MEDICAL HISTORY:
Not a known case of diabetes mellitus, hypertention, tuberculosis, epilepsy, asthama,

cardiac, renal or thyroid disorders.
FAMILY HISTORY:
No history of carcinoma breast, ovary, colorectal cancer in family.
PERSONAL HISTORY:
Diet- mixed
Appetite – reduced
Sleep- adequate
Bowel and bladder- normal and regular

GENERAL PHYSICAL EXAMINATION- Here is a middle aged female, moderately built and
nourished, conscious and cooperative, well oriented to time place and person.
Height- 148cm BP- 130/80 mmHg thyroid- NAD
Weight – 50kg PR- 96bpm breast- NAD
BMI- 22.8 kg/sq.mm SpO2- 98% spine- NAD
No signs of pallor/icterus/cyanosis/clubbing/lyphmadenopathy/pedal edema.
CVS- S1S2 present, no murmurs
RS- bilateral normal vesicular breath sounds present, no added sound
CNS- no focal or neurological focal deficits
PER ABDOMEN:
Inspection- Abdomen flat and scaphoid in shape
Umbilicus central and inverted
All correspomding quadrants move equally with respiration
Horizontal tubectomy scar present, healed by primary intension
No other scars or sinuses or engorged or dilated vessels seen.
All hernia orifices intact
Palpation- Inspectory findings confirmed,
Tubectomy scar present, healthy, non-tender
Firm to hard mass felt per abdomen, approximately corresponding to 14

week gravid uterus
Mass is mobile horizontaly, all borders are well made out except lower
border.
Surface is smooth, nontender
No local rise of temperature,
Dull note present on percussion over the mass
Auscultation- No bruit heard

Per speculum examination- Cervical growth of 2*1 cm noted, exophyticgrowth,with
irregular surface, reddish in colour, bleeds on touch.
Bimanual examination- uterus size smaller than normal, anteverted.
Induration felt on the growth, abdominal mass moves on moving cervix.All fornicesfree,
and posterior vaginal wall free
Per rectal examination- rectal mucosa free, left side indurated, short of lateral pelvic wall
DIAGNOSIS- carcinoma cervix stage 1B1

Eclampsia
Patients Name : Mrs X
Age : 20 years
Education : 7th class
Occupation : daily wage earner
Husbands Name : Mr X
Age : 2 years
Education : 7th class
Occupation : Daily wage earner
Resident of Itige, Bellary
Upper Lower socioeconomic status by Modified Kuppuswamy Scale
Chief complaints
Primigravida with 8 completed months of amenorrhea, appreciating fetal movements well,

came with complaints of
I. Headache since morning
II. 3 episodes of vomiting since morning
III. 2 episodes of convulsions in the afternoon
1. History of presenting complaints
A primigravida with 8 completed months of amenorrhea, appreciating fetal movements

well came with complaints of headache since morning, which was severe in intensity and
diffuse in location. It was associated with 3 episodes of vomiting. Vomiting was projectile in
nature, non bilious or Blood stained, aggravated on consumption of food and contained
undirected food particles.
Headache and vomiting were not associated with blurring of vision, epigastric pain
Patients attenders (sister and husband) give history of 2 episodes of convulsions, 10
minutes apart. The convulsions were of generalised tonic clonic type, associated with
frothing at the mouth and loss of consciousness between episodes. Patient was apparently
drowsy and confused after the last episode following which she regained normalcy after a
while.
No history of decreased urine output and swelling of feet
No history of pain abdomen, leaking or bleeding PV
No history of fever, cough, breathlessness
History of present pregnancy
1st Trimester : spontaneous conception, uneventful, Booked case in Itige Govt

Hospital
i. Diagnosed pregnant at 2 MOA by UPT at a Pvt Clinic Itige
ii. Took regular ANCs
iii. Folic Acid supplement taken, NT scan done and said to be normal
2 Trimester : Quickening felt at 5 MOA, uneventful
nd
i. Inj TT 2 doses taken, iron and calcium supplements taken

ii. Anomaly scan done and said to be normal
iii. No history of raised BP oo blood sugar levels, bleeding or spotting PV
3 Trimester : came with above complaints
rd
Obstetric history
Married life : 1 year, second degree consanguineous marriage, Primigravida

No history of contraceptive usage
Menstrual history
Age of menarche ; 13 years
Menstrual cycles : once in 3 to 4 days, regular, changes 2-3 pads per day, moderate flow,
associated with passage of clots, no dysmenorrhea
LMP : 20/12/2019
EDD : 27/09/2020
MEDICAL HISTORY
No history of Type 2 DM, HTN, Bronchial Asthma, epilepsy, cardiac, renal or thyroid
disorder
Past history:
No history of major surgeries, blood transfusion, drug allergy in the past
FAMILY HISTORY :
No history of hypertensive disorders in the family
No history of hypertensive disorders of pregnancy in the mother and sister
Personal history:
Diet : mixed and adequate
Appetite : good
Sleep : adequate
Bowl and bladder : regular
No history of chewing tobacco/betel nut or smoking
General physical examination
A young woman moderately bulls and nourished, well oriented to time, place and person,
conscious and Co-operative
No pedal edema
Pallor, cyanosis, clubbing, icterus : absent
BP : 160/110 mmhg in left upper arm, measured in supine position
Pulse : 90 bon, regular, good volume
RR : 18cpm
THYROID, SPINE & BREAST : clinically normal
Height of the patient : 147cm
Weight : 42 kg BMI : 19.4 kg/m2
Systemic examination
CVS : S1, S2 heard, no murmurs

RS : B/L equal air entry, no added sounds
CNS : no neurological deficits
PER ABDOMEN :
Inspection : abdomen distended uniformly, umbilicus central and everted, striae
gravidarum and linea nigra present. No scars, sinuses and dilated veins
Palpation : uterus 30 weeks size, relaxed
● Fundal grip – Breech felt
● Left lateral grip suggestive of spine
● Right lateral grip suggestive of limbs
● 1st pelvic grip : head lower pole, 2/5th palpable and engaged
● 2nd pelvic grip : confirms findings of 1st pelvic grip
Liquor feels clinically adequate

SFH : 28cm , AG : 31.5 inches
EFW by Johnson’s formula : 2.6kg
AUSCULTATION : FHS present, 130-140bpm, in left spino umbilical line
PER VAGINA : Cervix soft, central, about 1.5 cm in length, admitting 1 finger (1-2cm dilated
) membranes present, vertex at (-1). BISHOP score : 7
Pelvimetry :
i. sacral promontory not reached
ii. Sacrum well curved
iii. Side walls parallel
iv. Sacro sciatic notch admits 2 fingers
v. B/l spines not prominent
vi. Subpubic arch wide and admits 2 fingers and subpubic angle wide
vii. Outlet admits 4 knuckles
Pelvis adequate, no CPD
DIAGNOSIS
Primigravida with 34 weeks gestation with vertex presentation with IUGR with
Antepartum Eclampsia in latent labor
Term Pregnancy for Safe Confinement
Name: XYZ
Age: 23 years
Address: W/O ABC, Harihara
Occupation: Housewife
She is G3P2L2 with 9 calendar months of amenorrhoea, AFM well came for regular ANC.
- Patient is G3P2L2 with 9 months of amenorrhoea. She is appreciating fetal
movements well, came for regular antenatal checkup.
- No H/O burning micturition or increased frequency of micturition.
- No H/O generalized weakness, easy fatigability
2 MOA by BME and UPT at Devarahalli Government Hospital. Regular ANCs taken at
Nuggenahalli PHC
1st Trimester:
- No H/O increased frequency of micturition
2nd trimester :
- No H/O bleeding pv, pain abdomen
- Anomaly scan done at 5 MOA revealed low lying placenta and patient was advised
bed rest and to avoid strenuous activities.
- Tab. FS and Ca supplements taken regularly.
3rd trimester :
- She came for regular ANC
OBSTETRIC HISTORY
- Married life: 7 years.
- G3P2L2
- 1P
- She conceived 1 yr after marriage. Regulus ANCs were taken
- FTVD of a female baby of weight 2.5 kg at Devarahalli Government hospital.
.
- Baby was breast fed for 1 and half years. Attained milestones corresponding
- 2P
- FTVD of female baby of weight 2.8 kg, 2years old @ Devarahalli Government
hospital
- 3P
- Present pregnancy
MENSTRUAL HISTORY
- AOM - 12 years
- LMP-15/12/2019
- EDD- 22/9/2020
- POG : 39 weeks
PAST HISTORY
- Not a k/c/o HTN, DM, TB,Asthma or epilepsy
- No H/O previous surgery, D&C No H/O blood transfusion
FAMILY HISTORY
PERSONAL HISTORY
- Diet - Mixed
- Appetite - good
- Sleep - sound

- Temperature: 93 F
- PR - 92 bpm, regular rate and rhythm, good volume measured in right Radial artery
- BP - 110/70 mmHg in sitting position
- Height - 150 cm
- Weight - 52 kg
- No pallor, cyanosis, clubbing,icterus or Lymphadenopathy
- No pedal edema
- PER ABDOMEN :
- Inspection:
- Abdomen is uniformly distended
- Umbilicus central and stretched Linea nigra and striae gravidarum are
present.
- Uterus appears term size (with flanks full)
- Palpation:
- Uterus term size, relaxed longitudinal lie.
- SFH - 34cm AG- 94cm EFW - 3.4kg
- fundal grip - S/O breech
- Lateral grip-
- Right side S/O back
- Left side S/O limbs
- Pelvic grip-1
- S/O head lower pole, floating head
- Auscultation:
- FHS present, regular, 140-148 bpm, along the right spinoumbilical line
Per vaginum- Cervix soft, posterior, uneffaced os closed
G3P2L2 with 39 weeks of gestation with cephalic presentation for safe confinement.
ROLL NO 16- CASE 16
Prolapse
Name - Mrs.X
Age - 70yrs
Address - Amara devaragudda , Ballary
Education - illiterate
Occupation – Home maker
Socio economic status – Lower middle class family by modified KuppuSwamy classification
Chief complaints- P4l4 c/o mass per vagina since 10years
History of present illness
The mass per vagina was insidious onset since 10years, progressively increasing to the
present size since 4 to 5 months. Initially mass was small and reducible on its own, now
increasedto present size .
It increases in size on coughing, sneezing, straining and lifting weights. Associated with
discomfort wilewalking , massis manually reusable .
Feeling of incomplete evacuation of urine since 4 to 5 months present.
Not associated with increased frequency of micturition, burning micturition , stress

incontinence. No h/o defecation difficulties.
No h/o white discharge, foul smelling discharge, blood strained discharge or bleeding pv.
No h/o chronic cough, constipation, or history suggestive of mass per abdomen.
No h/o recent weight loss or loss of appetite .
No h/o of generalised weakness, or easy fatigability.
Menstrual history – AOM: 13years, previous menstrual cycles : regular cycles, attained
menopause 20years back .
Obstetrics history – Married life 40yrs, 3’ consanguineous marriage, P4L4.
1st pregnancy- FTVD/ female/37years/alive and healthy/ home delivery / birth weight not
known /attended by untrained dai /no prolonged labour/no h/o excessive blood loss/ no
h/o of perineal trauma.
2nd pregnancy- FTVD/ male/35years/alive and healthy/ home delivery / birth weight not
3rd pregnancy- FTVD/ female/33years/alive and healthy/ home delivery / birth weight
not known /attended by untrained dai /no prolonged labour/no h/o excessive blood loss/
no h/o of perineal trauma.
4th pregnancy- FTVD/ male/30years/alive and healthy/ home delivery / birth weight not
Patient underwent abdominalbilateraltubectomy 25years back.
Past history - No h/o blood transfusion, drug allergy, or any previous major abdominal
surgeries.
Medical history –Not a K/C/O hypertension, DM, epilepsy, asthma, tuberculosis ,cardiac
diseases, thyroid or renal diseases .
Family history – Nothing significant
Personal history -Nothing significant
A 60years old patient moderately built and nourished, conscious and co-operative, well
oriented to time place and person.
PR-89bpm, BP-116/70mmHg , Temperature-Afebrile, RR-15CPM.
Height – 150cm, weight – 56kg, BMI – 24.88Kg/m2
Thyroid , breast and spine are normal .
Pallor
Icterus
Cyanosis
Clubbing ABSENT
Lymphadenopathy
Oedema
CVS examination - S1&S2 present normal ,no murmur.

RS Examination – Bilateral NVBS present, no added sounds.
CNS – clinically normal.
Per abdomen –
Inspection-
abdomen normal in shape, abdominal obesity present ,flattened, tubectomy scar present
healthy ,no sinuses pulsations or engorged veins. Hernial orifices appears to be intact.
Palpation – all inspection findings are confirmed. Soft non tender no organomegally.
Auscultation –bowel sounds prsent.
Precaution- no signs of free fluid in the abdomen.
Local examination – pubic hair distribution sparse, vulvar pad of fat , labia majora and
minora are atrophied .
After valsalvamaneuver , uterus with cervix along with cystocele seen outside the introitus.
1st part to appear at introitus is cystocele ,Loss of vaginal wall rugosities . impulse on
coughing present. Decubitus ulcers over the anterior lip of cervix present.
Per speculum examination- 3rd degreeprolapse,
Anterior vaginal wall- grade 3 cystocele.
Posterior vaginal wall- grade 1 enterocele or rectocelepresent.
On reducing mass stress incontinence present.
Uterocervicallength- 5cm, cervical length- 3cm.
POP Q
Aa +2 Ba +4 C +2
GH 3cm Pb 3 TVL 7
Ab -2 Bb -1 D6
Bimanual examination- uterus atrophied firm, mobile and non tender, getting above the
swelling is absent.
Examination of the perineum- perineal body length- 3cm, levatorani muscle bulk atrophied,
tone reduced and symmetry normal.
Reflexes- bulbo cavernous reflex and anal wink reflex present and normal.
PR examination- anal sphincter tone normal.

ROLL NO 17- CASE 17
Anemia
NAME :X
AGE :25 YEARS
W/O MR.Y
ADDRESS :HARIHARA DAVANAGERE
EDUCATION :10 TH STANDARD
OCCUPATION :HOMEMAKER
SES : LOWER MIDDLE CLASS by modified kuppuswamy
Classification
CHIEF COMPLAINTS :
G3P2L1 with 8 months of ammenorrhea presents with tiredness, easy fatiguability and
swelling of lower limbs since 1 month.
HISTORY OF PRESENTING ILLNESS:

Patient c/o easy fatiguability and tiredness since 1 month, insidious in onset and
progressive in nature, progress towards the end of the day, relieved on taking rest.
Patient also c/o swelling of both lower limbs since 1 month, limited to the ankle, increased
on doing strenuous work, more in the evening, decreases on rest.
No h/o palpitations, breathlessness and chest pain
No h/o loss of appetite.
No h/o chronic cough and fever
No h/o bleeding per rectum, passage of worms, bare foot walking, hemetemesis.
No h/o burning micturition, increased frequency of micturituion.
No h/o head ache, nausea, blurring of vision, vomiting.
No h/o pain abdomen, bleeding pv, leak pv
HISTORY OF PRESENT PREGNANCY:

1 ST TRIMESTER: Booked case at government hospital Davangere. Concieved after 3
months of previous pregnancy, spontaneous conception
Folic acid supplementation taken
Dating scan done was told to be normal
No h/o hyperemesis
No h/o pain abdomen, spotting or bleeding pv
No h/o fever with rashes
No h/o drug intake o radiation exposure.
Blood test done and was normal.
No h/o increased tendency of micturition, burning micturition.
2 nd TRIMESTER: Qucikening at 5 months of ammenorrhoea.
1 st dose of TT taken at 4 th MOA
Iron and calcium supplements not taken regularly
Anomaly scan done and was told be normal
Blood investigation was told to be normal
No h/o pain abdomen, bleeding PV or leaking PV.
No h/o increased blood pressure recording.
3 rd TRIMESTER :Appreciating fetal movements well

Came with above complaints.
OBSTETRICS HISTORY:
ML:8 YEARS,NON CONSANGUINOUS MARRIAGE.
G3P2L1
1 ST PREGNANCY: Conceived spontaneously
FTVD/3KG/5 YEARS/ALIVE AND HEALTHY
No intrapartum, post partum complications.
h/o IUCD Insertion following 6 months of delivery removed
after 3 months i/v/o heavy menstrual bleeding.
2 nd PREGNANCY: Spontaneous conception 2 years ago.

Booked case at CG HOSPITAL,DVG.
Had regular ANC visits, anomaly scan done and was told to be normal.
Receievd 5 dose of iron sucrose in 5th month of pregnancy i/v/o anemia.
PTVD/FRESH STILL BORN/ MALE BABY/700 GMS 1.5 YEARS BACK.( NO
RETROPLACENTAL CLOT, NO C/O PAIN ABDOMEN, BLEEDING PV)
H/O 3 TIGHT LOOPS OF CORD AROUND THE NECK.
No h/o post partum blood transfusion and iron injections.
3 rd PREGNANCY: PRESENT PREGNANCY.
MENSTRUAL HISTORY:
AOM:12Years PMC:3-4Days/28-30 days
LMP:08/01/2020 moderate flow,regular, no clots,
EDD:15/10/2020 no dysmenorrhea
Scan EDD:14/10/2020(11WEEKS)
MEDICAL HISTORY:
Not a K/C/O DM, HTN, TB, Asthma, thyroid disorder, cardiac and renal disorder, epilepsy.
PAST and SURGICAL HISTORY:

No h/o any major surgeries in the past
No h/o blood transfusion
No h/o drug/ food allergies
No h/o malaria
PERSONAL HISTORY:
Diet : mixed
Appetite: normal
Sleep: adequate
Bowel n bladder: normal
Required Intake Deficit

Calorie (Kcal/day) 2175 1800 375
Protein (gram/ day) 63 52 13
Given h/o consumption of tea and coffee morning and evening
Consumption of rice and chapattis ( breakfast/ lunch/ dinner)

25 year old mother moderately build, nourished and conscious cooperative and well
oriented to time, place and person.
Height: 154 cm.
Weight(pre pregnancy): 54kg
BMI: 22.78 KG/M2
PRESENT WEIGHT: 63KG.
TOTAL WEIGHT GAIN IN PREGNANCY: 9 KG.
PALLOR: PRESENT GRADE -2, Over the lower palpebral conjunctiva and nail beds.
ICTERUS: ABSENT
CYANOSIS: ABSENT
OEDEMA: GARDE 1 B/L LOWER LIMB PITTING TYPE.
NO LYMPHADENOPATHY
NO Nail changes
No glossitis, chelitis.
Tongue appears bald, pale
JVP: not raised.
Pulse rate: 102 bpm
BP: 118/82 mm hg
RR: 14cpm
Urine albumin: nil
THYROID, SPINE,B/L BREAST : NORMAL
CVS: S1, S2 + , NO MURMURS , NO TACHYCARDIA.
RA: B/L NVBS+, NO ADDED SOUNDS.
CNS: NO FOCAL NEUROLOGICAL DEFICITS.
PER ABDOMEN:
Inspection:
Abdomen is uniformly distended, umbilicus central and everted,linea
nigra present, striae gravidarum present.
All hernia orifices intact.
PALPATION:
Abdominal gith: 76 cm.
Fundal grip: s/o breech.
Lateral grip: right - s/o limb buds, left- s/o spine.
1 st Pelvic grip: s/o head
EFWB by Johnsons formula : 2480 gms+/- 275 gms.
Liqour appears clinically normal
No organomegaly.
AUSCULTATION:
FHS +/REGULAR/144-148 BPM. On left spino umbilical line.
SUMMARY:
25 YEAR OLD , G3P2L1 WITH 33 WEEKS+2 DAYS OF GESTAION WITH
COMPLAINTS OF TIREDNESS, EASY FATIGAUBILITY, SWELLING OF B/L LOWER LIMBS,
HAILING FROM LOWER MIDDLE CLASS FAMILY WITH RECURRENT PREGNANCIES WITH
GRADE 2 PALLOR AND GRADE 1 PEDAL ODEMA WITH NO CHANGES OF CARDIAC
FAILURE.
ON PER ABDOMEN EXAMINATION: UTERUS IS OF 32 WEEKS SIZE, RELAXED REGULAR
FETAL HEART SOUNDS+
DIAGNOSIS: 25 YEAR OLD G3P2L1 WITH 33 WEEKS+2 DAYS OF GESTATION WITH

CEPHALIC PRESENTATION WITH GOOD CARDIAC ACTIVITY WITH ANEMIA NOT IN
FAILURE AND NOT IN LABOUR.
INVESTIGATION:
HB: 8.0 GM/DL
TLC: 7000 CELL/CUMM
DLC: N: 68%, L: 29%, E:2%, M : 1%
ESR: 22CM/HR
BLOOD GROUP: B POSITIVE.
RBS: 88 MG/DL
HIV AND HbSAg: non reactive
TSH: 2.47 mIU/ml
MCV: 68fl
MCH:25pg
MCHC:28%
PS: MICROCYTIC HPOCHROMIC BLOOD PICTURE WITH ANISOPOIKILOCYTOSIS
STOOL EXAMINATION NO OVAL CYSTS
AUB
NAME- Bi bi Ayesha DATE OF ADMISSION- 29/6/2020
AGE-44yrs DATE OF EXAMINATION-29/6/2020
OCCUPATION-homemaker
ADDRESS-Davangere.
CHIEF COMPLAINTS-heavy menstrual bleeding- 6 months
Patient was apparently normal 6 months back and then she developed heavy bleeding
during menstruation since 6 months. Patient bleeds for 7-8 days, changes- 4-5 pads per day
, associated with passage of clots.
Patient also complaints of pain abdomen, insidious in onset, starts one day before menses
and present for 1st and 2nd day of cycle, colic type of pain, present in the lower abdomen
radiating to thigh, no aggrevating factors relieved on taking medication, associated with
generalised weakness.
No c/o-easy fatigability, palpitations/ chest pain
No c/o intermenstrual bleeding, post coital bleeding.
No c/o foul smelling discharge per vagina/ white discharge per vagina
No c/o increased frequency of micturition of retention of urine
No h/o IUCD insertion
No h/o headache blurring of vision
No h/o fever, cough and cold
No h/o loss of weight/ loss of appetite/ cold intolerance
MENSTRUAL HISTORY
AGE OF MENARCHE-14yrs
LMP-6 days back
Previous menstrual cycle-3-4/30days, regular, moderate flow no clots,

no dysmenorrhea.
Present menstrual cycles-7-8/ 28-30 days, regular , heavy flow, clots+
Dysmenorrhoea+
Patient changes 4-5 fully soaked pads per day for the first 3-4 days.
OBSTETRIC HISTORY
ML-27 years NCM P1L1A1
P1- spontaneous abortion at 21/2 MOA
P2-FTVD/male/24years/A and H/@CGH,
Breast feed for 2 years, no h/o contraceptive usage.
PAST HISTORY- no h/o blood transfusion
No h/o drug allergy
No h/o any other surgery
MEDICAL HISTORY- not a known case of DM/HTN/ IHD/ BA/ PTB/ EPILEPSY/
cardiac/ thyroid/ renal disorders.
FAMILY HISTORY- nothing significant.
PERSONAL HISTORY- DIET-mixed
APPETITE-good
SLEEP-adequate
BOWEL AND BLADDER- regular
GENRAL PHYSICAL EXAMINATION
Patient is moderately built and nourished, conscious, co-operative, well oriented to time
place and person.
PR-84bpm BP-130/84mmHg
Pallor+ thyroid , breasts , spine- clinically normal
No clubbing
No cyanosis
No icterus
No lymphadenopathy
No pedal oedema
CVS- S1 S2 + NO MURMURS
RS- B/L NVBS
PER ABDOMEN- INSPECTION
- Abdominal obesity +
- Umbilicus central and inverted
- No scars and sinuses
- No dilated veins
- No visible pulsations
- Hernia orifices normal and intact
PALPATION- no local rise of temperature
A single mass of 12- 14 week size of gravid uterus + in the suprapubic region, smooth
surface, firm in consistency.
borders– superior border and B/L lateral borders are well made out, inferior border not
palpable.
Mobility- horizontal mobility +
Nontender
PERCUSSION- dull on percussion
GYNACOLOGICAL EXAMINATION:-
EXTERNAL GENITELA- pubic hair distribution normal
Vulval pad of fat normal
Labia majora/ minora- normal
PER SPECULUM EXAMINATION- bleeding through os +
BME- cervix is firm directed upward and backward. Uterus is retroverted 14 weeks size
firm non tender. Transmitted mobility +
B/L fornices free, non tender.
PER RECTAL EXAMINATION- normal
PROVISIONAL DIAGNOSIS- FIBROID UTERUS
INVESTIGATIONS
HB-8.2gm%
TC- 10,500cell/cumm
BG- B+
PLT- 2.8lakh
USG- uterus retroverted, 11.1*7.3 cm, with anterior wall fibroid of 7.2*6.4*6.5 cm, with
endometrial thickness- 3mm
ROLL NO 19- CASE 19
Cardiac case
Name - Mrs.X
Age - 26yrs
Address -Chitradurga
Education - 7thstd
Occupation – Home maker
Socio economic status – Lower middle class family by modified KuppuSwamy classification
Chief complaints-
Primigravida with 9MOA, AFM well came for safe confinement
No h/o pain abdomen, leaking PV or bleeding PV
No h/o chest pain, palpitation, breathlessness, or giddiness
No h/o of night time cough or peripheral bluish discolouration
No h/o fever, cough, cold or dental infection
No h/o burning micturition or increased frequency of micturition
No h/o headache, epigastric pain, blurring of vision, nausea or vomiting
History of present pregnancy
Conceived after 3yrs of married life, pregnancy detected by UPT and confirmed by
bimanual examination. Regular ANC taken at Holalkere private hospital.
1st Trimester
No h/o excessive vomiting,
No h/o bleeding pv or spotting pv
No h/o burning micturition ,
No h/o fever with rashes,
No h/o drug intake or radiation exposure, tablet folic acid taken .
2nd Trimester
Quickening felt at 5 months of amenorrhea,

Anomaly scan done told to be normal,
Iron & Calcium supplemented regularly,
Inj TT 2 doses taken,
No h/o chest pain, palpitation, breathlessness, or giddiness.
3rd Trimester – Appreciating fetal movements well, came for safe confinement.
Obstetrics history –
Married life 4yrs 3’consanguineous marriage,
Primigravida
Menstrual history –
AOM: 10years,
Previous menstrual cycles : regular cycles, 3 to 4 days moderate flow, cycles of 28 to

30days, changes 2 to 3 pads for day, no h/o dysmenorrhea and passage of clots.
LMP- 5/2/019,
USG EDD (9 Wks) -15/11/2019
Past history –
No h/o blood transfusion, drug allergy, or any previous surgeries.
Medical history –
K/C/O ventricular septal defect since 3years, not on any medication
Not a K/C/O hypertension, DM, epilepsy, asthma, tuberculosis , thyroid or renal diseases .
Family history – Nothing significant
Personal history -Nothing significant
A 26years old female moderately built and nourished, conscious and co-operative, well
oriented to time place and person.
PR-82bpm, BP-106/70mmHg , Temperature-Afebrile, RR-15CPM, SPO2-99%
Height – 156cm, Weight – 60kg BMI – 24.69Kg/m2

Thyroid, breast and spine are normal .
Pallor
Icterus
Cyanosis
Clubbing ABSENT
Lymphadenopathy
Oedema
CVS examination-
Inspection of neck-
JVP-normal 3cm,
Trachea – midline,
Thyroid Normal.
No visible pulsation are seen.
Inspection of chest –
Normal shape and symmetrical, no precordial bulge, no dilated veins, scars, pulsations or
sinuses.Apical impulse not visible.
Palpation –
Apical impulse located at left 5th intercostal space, medial to mid clavicular line. No
parasternal heave, gastric pulsation, or thrills.
Percussion – upper border- liver dullness at right 5th intercostal space at midclavicular line,
right border- corresponds to right sternalborder, left border corresponds to apex beat.
Auscultation – S1&S2 present normal , pan systolic murmur in aortic and pulmonary area.
RS Examination – Bilateral NVBS present, no added sounds.
CNS – clinically normal.

Per abdomen – Inspection- abdomen uniformly distended, flanks full, umbilicus flattened,
lineanigra present, striagravidarum present, no scars sinuses pulsations or engorged veins.
Hernial orifices appears to be intact.
Palpation – all inspection findings are confirmed, uterus term size, relaxed
Fundal grip- soft broad irregular mass palpable
Lateral grip- right side – uniform hard resistance felt, left side – multiple irregular knob like
structures felt.
1st pelvic grip – hard regular globular mass ,ballatable , 5/5th palpable.
SFH- 32cm, AG- 94cm/37”
Auscultation – FHS present /regular /140-145bpm at right spino umbilical line.
Per vaginal examination – cervix soft, posterior, uneffeced, os closed, Vertex above brim.
Recurrent Pregnancy Loss
Mrs X
w/o Mr. A
26yr old
Home maker
Address- Hadne, Davangere
Chief complaints:
G4A3 with 1 and a half months of amenorrhea came to the OPD for her 1st antenatal visit
after diagnosing her pregnancy at home by a home pregnancy kit. Now patient is anxious
about the progress of her current pregnancy.
History of Present Pregnancy:
Patient conceived after 1 year of last pregnancy.
Pregnancy was diagnosed by a urine pregnancy test.
No c/o vaginal discharge, spotting per vaginum, pain abdomen.
No c/o fever with rash, increased frequency of micturition, burning micturition. No c/o
galactorrhea
No c/o nausea, vomiting
Obstetric History:
Married life- 5yrs, non consanguineous marriage,
Gravida 4 Abortion 3
P1- Patient conceived after 2 yrs of married life. Pregnancy was diagnosed by UPT at a local
PHC at 1 and a half months of amenorrhea. At 2 months of amenorrhea patient was taken
to the hospital with c/o bleeding per vaginum associated with passage of clots and fleshy
material. Patient was examined after the hospital and given oral tablets after which the
bleeding subsided.
P2- Patient conceived after 1year of the 1st abortion. Pregnancy was diagnosed by UPT at
home and confirmed by USG at 2 months of amenorrhea. Patient went to the hospital
2weeks later with c/o spotting per vaginum associated with lower back pain. A USG was
done which showed no fetal cardiac activity following which patient underwent a dilatation
and evacuation procedure.
P3- Patient conceived after 1year of abortion. Pregnancy was confirmed by UPT followed
by USG at 2 months of amenorrhea. Patient was started on a oral tablet and was given an I.
m. Injection I/ v/o the past obstetric history. Patient went back to the hospital 1montb later
with c/o spotting per vaginum and pain abdomen. On USG it was confirmed that there was
absent fetal cardiac activity. Patient underwent dilatation and evacuation after that.
Menstrual history:
Age of menarche- 13yrs
Previous menstrual cycles- 3-4/30+-2 days, regular cycles, moderate flow, no clots, no
dysmenorrhea, no intermenstrual bleeding, no coital bleeding. LMP- 01/07/2020
EDD- 08/04/2021
Period of gestation- 7weeks + 1 day
Past history:
Patient is not a known case of DM, TB, hypertension, bronchial asthma, epilepsy,
cardiovascular disorders, thyroid disorders, renal disorders.
No h/o galactorrhea in the inter conceptional period
No h/o major surgery
No h/o allergy to any drugs
No h/o blood transfusion
Family history:
Mother is a k/c/o hypertension since 3years on treatment
No h/o thrombophlebitis, thyroid disorders, DM
No h/o recurrent abortions in first degree relatives.

Personal history:
Diet- vegetarian
Appetite- normal
Sleep- adequate
Bowel and bladder habits- regular
No h/o smoking, alcohol, or excessive caffeine consumption
Here is a 26year old patient who is moderately built and nourished.
Patient is conscious, cooperative and well oriented to time, place and person.
Anthropometric Examination:
Height- 156cm Weight- 58kg BMI- 23.8 kg/m2
Vitals:
BP- 110/78mmHg
PR- 88bpm, regular, good volume pulse
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema
Thyroid, breast and spine are clinically normal
Systemic examination:
CNS- clinically normal
RS- bilateral normal vesicular breath sounds heard, no added sounds
CVS- S1, S2 heard, no murmurs
Per Abdomen-
Inspection-
All quadrants move equally with respiration,
Umbilicus central and inverted,
No dilated veins, engorged sinuses or scars,
Hernial orifices appear normal and intact

Palpation-
Inspectory findings confirmed on palpation,
Abdomen soft and non tender
Auscultation-
Bowel sounds present
Bimanual Examination-
Uterus 6-8 weeks size, anteverted, mobile, bilateral cornices free and non tender
Summary-
Here is a 26year old patient who is a 4th gravida with 3 previous 1st trimester miscarriages
with a current pregnancy of 7weeks and 1day of gestation

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ROLL NO 1- CASE 1

NAME-Mrs.ABC W/O XYZ DOA-29/5/2020

AGE-30 yrs DOE-29/5/2020

SOCIO- ECONOMIC STATUS- upper middle class

Primigravida with 7 months of amenorrhea , appreciating fetal movements well, is referred

No c/o pain abdomen

No c/o bleeding per vagina/ leaking per vagina

No c/o burning micturition/ increased frequency of micturition

No c/o headache/ blurring of vision / epigastric pain

No c/o chestpain /palpitations/ easy fatigability

No c/o fever with chills/ cough/ cold

HISTORY OF PRESENT PREGNANCY

Patient conceived spontaneously in 2yrs of marriage. No contraceptives used. Pregnancy

1 TRIMISTER-Tab.folic acid taken .

No h/o hyperemesis gravidarum/bleeding or spotting pre vagina.

No h/o fever with rash and urinary disturbances.

2 TRIMISTER- quickening felt at 5 months of amenorrhea,

Tab Iron and Calcium taken

Anomaly scan -24 weeks of gestation – shows no abnormalities detected,

No h/o bleeding per vagina/ pain abdomen / PIH symptoms

3 TRIMISTER – patient was diagnosed as GDM at 7 months of amenorrhea in harihar

Married life- 2 yrs non –consanguineous marriage

Age of menarche-14 yrs

Previous menstrual cycle-3-4/30 days, regular, moderate flow, no clots ,

USG EDD[ 24 WKS]- 26/9/2020

PERIOD OF GESTATION- 31 WEEKS 6 DAYS

PAST HISTORY- No h/o blood transfusion

No h/o drug allergy

No h/o any surgery

Not a known case of – hypertension/ bronchial asthma/ tuberculosis/ epilepsy/ cardiac/

FAMILY HISTORY- mother is a K/C/O – type 2 DM- on oral hypoglycemic agents

BOWEL AND BLADDER- regular.

GENERAL PHYSICAL EXAMINATION

No -Pallor/ icterus/clubbing / cyanosis/ lymphadenopathy/ pedal edema.

ANTHRPOMETRY – HEIGHT- 150cm

PRE PREGNANCY WEIGHT- 60Kg BMI-26.6

PRESENT WEIGHT -72Kg

THYROID/ BREAST/ SPINE- CLINICALLY NORMAL

BP- 136/84mmHg measured in sitting position

PULSE- 90bpm, regular rhythm, good- volume.

CNS- HMF NORMAL

PER ABDOMEN – uterus 28 week size

External ballottement present. FHS+ Regular 150-160bpm

SES: Lower middle case

Husband-40years, Farmer by occupation

c/o discharge per vaginum since 1 month

No h/o similar complaints in the past.

No h/o burning micturition, increased frequency of micturition.

No h/o dyspareunia / pain abdomen.

No h/o post coital bleeding/ mass per vaginum

No h/o evening rise of temperature, cough, chills and rigors.

Married life- 17 years

1st P= FTND / Male/ 16 years/ alive and healthy/ Home delivery

Tubectomised 10 years back

No h/o major surgeries in the past.

No h/o blood transfusions

No h/o drug allergies

She is known case of type 2 diabetes mellitus and on tab glimepiride

Not a known case of hypertension, brochial asthama, epilepsy, tuberculosis