OBG Cases-1 - 240402 - 092346
OBG Cases-1 - 240402 - 092346
OBG Cases-1 - 240402 - 092346
(1) GDM
ADDRESS-Harihar
EDUCATION-8thstd
OCCUPATION-home maker
[modifiedkuppaswamy scale]
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 .
OBSTETRIC HISTORY
Primigravida
MENSTRUAL HISTORY
LMP-23/12/2019
EDD-30/9/2020
PERSONAL HISTORY-
DIET- mixed
APPETITE- good
SLEEP- adequate
A 30yr old patient moderately built and nourished, conscious, cooperative well oriented to
time place and person.
VITALS- TEMPERATURE-afebrile
SYSTEMIC EXAMINATION-
CVS/RS- NAD
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
CHIEF COMPLAINTS:
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.
OBSTETRIC HISTORY:
P2L2
2nd P= FTND/ Female /13 years/ Alive and healthy/ Home delivery
MENSTUAL HISTORY:
AOM: 13years
LMP: 10/7/2020
PMC= 3-4/28-30 days, regular, moderate flow, No clos/dysmenorrheal
PAST HISTORY:
SEXUAL HISTORY:
Single partner
PERSONAL HISTORY:
Diet- Mixed
Sleep- Sound
Appetite- Adequate
A middle aged lady who is moderately built and poorly nourished, conscious, co-operative
and well oriented to time, place and person
Height- 158 cm
Weight- 40kg
PA-
Inspection:
Palpation:
No organomegaly
Vulva-Congested
Scratch marks are present over inner aspects of thigh and in labia major and minora
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
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
- No H/O headache, blurring of vision, epigastric pain
- 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
GENERAL PHYSICAL EXAMINATION
- 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
SYSTEMIC EXAMINATION:
- 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
CHIEF COMPLAINTS:
She was brought to OPD by her mother with H/O not attained menstrual cycles.
HOPI:
MENSTRUAL HISTORY:
OBSTETRIC HISTORY:
Unmarried
PAST HISTORY:
No H/O tuberculosis
Nothing significant.
PERSONAL HISTORY:
Diet-Veg
Appetite-Adequate
Sleep-Sound
A young female average built and nourished. Comfortable and co-operative at the time of
examination.
Wt-37kg
BMI-18.13kg/m sq
PR- 88bpm
Spine- Normal
Systemic Examination:
Abdominal examination:
Inspection:
Palpation:
- Soft, non-tender.
- No organomegaly
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:
Karyotype- 45 X0
Transverse lie
Name: XYZ
Age: 28 years
W/O ABC
Address: Bellary
Occupation: Housemaker
SES: Lower middle socioeconomic class according to Modified Kuppuswamy Classification
She is G3P2L2 with 9 calendar months of amenorrhoea, AFM well came for regular antenatal
check-up
She conceived spontaneously 2 ½ years after previous child birth. Diagnosed pregnancy at
2 MOA by UPT and confirmed by scan at Hagaribommanahalli Government Hospital.
Regular ANCs taken at Kottur PHC.
1st Trimester:
- No H/O excessive nausea/vomiting
- No H/O spotting PV/bleeding PV
- No H/O pain abdomen
- No H/O increased 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
- No H/O headache, blurring of vision, epigastric pain
- Anomaly scan done at 5 MOA and told to be normal.
- 2 doses inj TT taken at 4th MOA and 5th MOA.
- Tab.FS and Ca supplements taken regularly.
3rd trimester :
- She came for regular ANC.
OBSTETRIC HISTORY
- Married life : 7 years.
- Non consanguineous marriage
- 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.
- No antepartum and intrapartum complications. She was discharged on PND3
.
- Baby was breastfed for 1 and half years. Attained milestones corresponding
to age. Well immunized
- 2P
- FTVD of female baby of weight 2.8 kg, 2years old at Nagenahalli Government
hospital
- No H/O contraceptive usage in the inter pregnancy interval
- 3P
- Present pregnancy
MENSTRUAL HISTORY
- AOM - 12 years
- LMP-15/12/2019
- EDD- 22/9/2020
- 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, 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
GENERAL PHYSICAL EXAMINATION
- She is moderately built and nourished, cooperative
- Temperature: 93 F
- PR - 92 bpm,
- BP - 110/70 mmHg
- 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, edema or lymphadenopathy
SYSTEMIC EXAMINATION:
- CVS, RS, CNS - Clinically Normal
- 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.
- No scars or dilated veins
- Hernial orifices appear intact.
- 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
PROVISIONAL DIAGNOSIS:
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
CHIEF COMPAINTS:
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.
MENSTRUAL HISTORY:
AOM- 13 year
ML- 28 years
P2L2
Concieved spontaneously.
PAST HISTORY:
-H/O spotting PV 1 year back, for which she didn’t seek any medical advice.
FAMILY HISORY:
PERSONAL HISTORY:
No supraclavicular lymphadenopathy
Performance score-1
Abdominal Examination:
Inspection-
Palpation:
Percussion:
- Dullness made over the mass area. Rest of the abdomen- normal. No shifting
dullness.
External genitalia:
Normal
Per Speculum:
Bimanual Examination:
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
Booked case
Tab. Folic acid taken regularly. Routine investigations done and blood is found to be B
negative.
Obstetric History:
G3P1L1A1.
Menstrual History:
AOM:14 YRS
LMP:16/9/2019
EDD:23/6/2020
POG:38 +6
Past h/o:
MEDICAL HISTORY:
PERSONAL H/O:
Diet –mixed,
Appetite- good,
Sleep –adequate,
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
CVS/RS: NAD
Per Abdomen:
INSPECTION:
PALPATION:
- left-s/o limbs
1st pelvic grip-s/o head ,2/5th palpable
AUSCULTATION:
Per vaginum : Cervix soft, central, 75% effaced, 3 cm dilated ,membranes absent, clear leak
+. Vertex at 0 station.
ROLL NO 8- CASE 8
Infertility
Age- 30yrs
Address- Davangere
Homemaker
CHIEF COMPLAINTS:
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
MENSTRUAL HISTORY:
AOM: 12 years
LMP: 17.07.2019
OBSTETRIC HISTORY:
ML - 4 yrs NCM
Nulligravida
PAST HISTORY:
PERSONAL HISTORY:
Sleep adequate
FAMILY HISTORY:
MALE FACTORS:
SYSTEMIC EXAMINATION:
PER ABDOMEN:
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
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
No history of leaking PV
1sttrimester :
2ndtrimester :
3rdtrimester :
OBSTETRIC HISTORY :
1P : Present pregnancy
Menstrual history :
3-4 days cycles regular , 28-30 days moderate flow ,No clots /No dysmenorrhea
PAST HISTORY :
PERSONAL HISTORY :
Diet : Mixed
Appetite : Good
Sleep : Sound
Patient is moderately built,moderately nourished, well oriented to time , place and person .
She is conscious and co-operative
Temperature ; 98^F
No Pedal edema
Height :149 Cm
Weight :57 Kg
SYSTEMIC EXAMINATION
PER ABDOMEN :
No scars / sinuses
Fundal grip : Hard ballotable mass felt below right hypochondrium suggestive of head
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
IUGR
NAME - ABC
AGE: 22 YEARS
HOME MAKER
OCCUPATION:SHOPKEEPER
MONTHLY INCOME:19000
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 swelling of lower limbs noticed from past 15 days,not releving on rest or in
supine position.
I TRIMESTER:
II TRIMESTER:
• 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:
• Gravida 2 abortion 1
• II pregnancy:present pregnancy
MENSTRUAL HISTORY:
• Past menstrual cycles:3-4 days for every 28-30 days,changes 3 pads per day,no h/o
passage of clots or dysmenorrhea.
Medical history:
FAMILY HISTORY:
PERSONAL HISORY:
• Diet:mixed
• Appetite: normal
• Sleep: adequate
• Diet :
• • •
REQUIRE IN
D T
A
K
E
• CALORIE( • 2175 •
KCAL/DAY) 1
8
0
0
• PROTEIN( • 65 •
GMS/DAY) 5
2
Young mother,moderately built and nourished,alert and oriented to time, place and person.
• No pallor,icterus,cyanosis,clubbing,lymphadenopathy
• Urine albumin-loaded
Systemic examination:
Per abdomen:
Inspection:
Palpation:
Liquor:clinically normal
Lateral grip- right side: knob like structures felt suggestive of fetal limbs
Auscultation:
Fetal heart sounds-150 beats per minute heard along the spino umbilical line on the left
side.
Per vagina:
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.
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
SLIUG corresponding to 32wk 3 days +/-3 wk with IUGR and normal liquor,
BPP- 6/8
ROLL NO 11- CASE 11
Mass PA
Age-35yrs
Illiterate
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.
PMC= 3-4/ 28-30 days ; Regular, Moderate flow, Changes 3 moderately soaked cloth pads
per day, No clots or dysmenorrhea.
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:
Family History:
Personal History:
Systemic Examination:
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-
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.
PROVISIONAL DIAGNOSIS- Right sided ovarian benign tumor for further evaluation
INVESTIGATIONS-
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
Address - Malebennur
Occupation - homemaker
Chief complaints-
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
OBSTETRIC HISTORY
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
Menstrual history-
Past menstrual cycle –3/30 days cycle regular, moderate flow ,no clots , no dysmenorrhea
LMP- 04/09/2019
EDD –11/06/20
PAST HISTORY –
No history of blood transfusion
PERSONAL HISTORY
Diet - mixed
Appetite – altered.
Sleep –disturbed , she prefers to sleep on left lateral side
Bowel and bladder –regular and normal
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 :
68kg at present
Vitals – Afebrile
Systemic Examination–
Respiratory system –bilateral normal vesicular breath sounds heard , no added sounds
Per abdomen -
Inspection -
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-
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
She also complaints of loss of appetite and loss of weight since 6 months.
MENSTRUAL HISTORY:
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.
PAST HISTORY:
MEDICAL HISTORY:
FAMILY HISTORY:
PERSONAL HISTORY:
Diet- mixed
Appetite – reduced
Sleep- adequate
SYSTEMIC EXAMINATION
PER ABDOMEN:
Mass is mobile horizontaly, all borders are well made out except lower
border.
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
Eclampsia
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
Obstetric history
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
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
DIAGNOSIS
Primigravida with 34 weeks gestation with vertex presentation with IUGR with
Antepartum Eclampsia in latent labor
ROLL NO 15 – CASE 15
Name: XYZ
Age: 23 years
Address: W/O ABC, Harihara
Occupation: Housewife
SES: Lower middle socioeconomic class according to Modified Kuppuswamy Classification
She is G3P2L2 with 9 calendar months of amenorrhoea, AFM well came for regular ANC.
HISTORY OF PRESENTING PREGNANCY:
- Patient is G3P2L2 with 9 months of amenorrhoea. She is appreciating fetal
movements well, came for regular antenatal checkup.
- No C/O pain abdomen, leaking PV
- No H/O burning micturition or increased frequency of micturition.
- No H/O generalized weakness, easy fatigability
- No H/O headache, blurring of vision, epigastric pain
- No H/O fever, cough/travel history
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/O increased 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
- No H/O headache, blurring of vision, epigastric pain
- 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 for regular ANC
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-15/12/2019
- EDD- 22/9/2020
- POG : 39 weeks
- 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
SYSTEMIC EXAMINATION:
- 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 term size (with flanks full)
- No scars or dilated veins
- Hernial orifices appear intact.
- 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
PROVISIONAL DIAGNOSIS:
G3P2L2 with 39 weeks of gestation with cephalic presentation for safe confinement.
ROLL NO 16- CASE 16
Prolapse
Name - Mrs.X
Age - 70yrs
Education - illiterate
Socio economic status – Lower middle class family by modified KuppuSwamy classification
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 .
No h/o white discharge, foul smelling discharge, blood strained discharge or bleeding pv.
Menstrual history – AOM: 13years, previous menstrual cycles : regular cycles, attained
menopause 20years back .
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
known /attended by untrained dai /no prolonged labour/no h/o excessive blood loss/ no
h/o of perineal trauma.
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
known /attended by untrained dai /no prolonged labour/no h/o excessive blood loss/ no
h/o of perineal trauma.
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 .
A 60years old patient moderately built and nourished, conscious and co-operative, well
oriented to time place and person.
Pallor
Icterus
Cyanosis
Clubbing ABSENT
Lymphadenopathy
Oedema
Systemic examination
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.
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.
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.
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.
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.
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.
PERSONAL HISTORY:
Diet : mixed
Appetite: normal
Sleep: adequate
Bowel n bladder: normal
SYSTEMIC EXAMINATION:
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+
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
ROLL NO 18 – CASE 18
AUB
OCCUPATION-homemaker
ADDRESS-Davangere.
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 foul smelling discharge per vagina/ white discharge per vagina
MENSTRUAL HISTORY
AGE OF MENARCHE-14yrs
Dysmenorrhoea+
Patient changes 4-5 fully soaked pads per day for the first 3-4 days.
OBSTETRIC HISTORY
MEDICAL HISTORY- not a known case of DM/HTN/ IHD/ BA/ PTB/ EPILEPSY/
cardiac/ thyroid/ renal disorders.
APPETITE-good
SLEEP-adequate
Patient is moderately built and nourished, conscious, co-operative, well oriented to time
place and person.
PR-84bpm BP-130/84mmHg
No clubbing
No cyanosis
No icterus
No lymphadenopathy
No pedal oedema
SYSTEMIC EXAMINATION
CVS- S1 S2 + NO MURMURS
- Abdominal obesity +
- Umbilicus central and inverted
- No scars and sinuses
- No dilated veins
- No visible pulsations
- Hernia orifices normal and intact
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.
Nontender
GYNACOLOGICAL EXAMINATION:-
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.
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
Socio economic status – Lower middle class family by modified KuppuSwamy classification
Chief complaints-
Conceived after 3yrs of married life, pregnancy detected by UPT and confirmed by
bimanual examination. Regular ANC taken at Holalkere private hospital.
1st Trimester
2nd Trimester
3rd Trimester – Appreciating fetal movements well, came for safe confinement.
Obstetrics history –
Primigravida
Menstrual history –
AOM: 10years,
LMP- 5/2/019,
Past history –
Medical history –
Not a K/C/O hypertension, DM, epilepsy, asthma, tuberculosis , thyroid or renal diseases .
A 26years old female moderately built and nourished, conscious and co-operative, well
oriented to time place and person.
Pallor
Icterus
Cyanosis
Clubbing ABSENT
Lymphadenopathy
Oedema
Systemic examination
CVS examination-
Inspection of neck-
JVP-normal 3cm,
Trachea – midline,
Thyroid Normal.
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.
Palpation – all inspection findings are confirmed, uterus term size, relaxed
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.
Per vaginal examination – cervix soft, posterior, uneffeced, os closed, Vertex above brim.
ROLL NO 20 – CASE 20
Mrs X
w/o Mr. A
26yr old
Home maker
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.
No c/o fever with rash, increased frequency of micturition, burning micturition. No c/o
galactorrhea
Obstetric History:
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:
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
Past history:
Patient is not a known case of DM, TB, hypertension, bronchial asthma, epilepsy,
cardiovascular disorders, thyroid disorders, renal disorders.
Family history:
Diet- vegetarian
Appetite- normal
Sleep- adequate
Patient is conscious, cooperative and well oriented to time, place and person.
Anthropometric Examination:
Vitals:
BP- 110/78mmHg
Systemic examination:
Per Abdomen-
Inspection-
Auscultation-
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