Obstetrics n Gynaecology cases

7/23/2019 Obstetrics n Gynaecology cases

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Obstetrics n Gynaecology MADEEASYCOMPILED BY DR.DEEVISH N D

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ABOUT

CLINICAL CASES (GYNAECOLOGY)

CLINICAL CASES (OBSTETRICS)

GALLERY

PRACTICAL OBG

SAMPLE CHAPTERS

RSS

CLINICAL CASES (OBSTETRICS)

CASE 1 – ANEMIA IN PREGNANCY

CASE 2 – PREGNANCY INDUCED HYPERTENSION (PRE-ECLAMPSIA)

CASE 3 – PREVIOUS CAESAREAN SECTION

CASE 4 – Rh NEGATIVE PREGNANCY

CASE 5 – HEART DISEASE IN PREGNANCY – 1

CASE – HEART DISEASE IN PREGNANCY – 2

1. CASE OF ANAEMIA IN PREGNANCY

N!"# – V!$!%&h!""! H'$!%*S N!"# – B!+,!%!!

A/# – 30 #!$ A/# – 35 #!$

A#$$ – N#,!"!%/!,! O'!&+% – C,+#

O'!&+% – H'$#+6# I%"# – R$. 33007"%&h

R#,+/+% – H+%' SE S&!&'$ – U# L# ,!$$

G3P2L2 "#$ +&h 8 "%&h$ 6 !"#%h#!

PRESENTING COMPLAINTS – E!$ 6!&+/!+,+& $+%# 2 "%&h$

HISTORY OF PRESENTING COMPLAINTS:• P!&+#%& #$#%&$ +&h 8 "%&h$ 6 !"#%h#! +&h #!$ 6!&+/!+,+& $+%# 2 "%&h$. P#9+'$,:

&h# !&+#%& !$ !,# & h# h'$#h, ;: '& 6 &h# !$& 2 "%&h$: $h# /#&$ &+# #9#% +&h

"+%+"!, ;. O% !,;+%/ !'& 50 ": !&+#%& ",!+%$ 6 6!&+/!+,+&: /++%#$$: ,'+%/ 6 9+$+%

h+h +$ #,+9# % #$&.

• N h+$& 6 +%#!$# ,##+%/ '+%/ "#%$#$ + & #/%!%.

• N h+$& 6 #<#&+%!, $%#!: !,+&!&+%: PND: #!, ##"! /++%#$$.

• N h+$& 6 ,##+%/ ,#!; PV.

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• N h+$& 6 ,##+%/ PR "!,#%!.

• N h+$& 6 !$$+%/ "$ +% &h# $&,$.

• N h+$& 6 6#9# +&h h+,,$ !% '%+%/ "+&'!&+%.

• N h+$& 6 '/h +&h #<#&!&+%: h#"&$+$: #9#%+%/ +$# 6 &#"#!&'# %&!& +&h !

;%% !$# 6 &'#',$+$.

•

N h+$& 6 '/ +%&!;# (!%&+-"!,!+!, '/$ !$++%).• N h+$& 6 !% #,,+$h +$,'!&+% 6 $;+% !% $,#!.

• N& ! ;%% +!#&+ h#&#%$+9#.

OBSTETRIC HISTORY:

M!+# L+6# – 13 #!$: N%-%$!%/'+%'$

O$&#&+ +%#< – G3P2L2

No

. DELIVERY

BABY AT

BIRTH

PRESENT

AGE COMMENTS

G1

FTND,Government

Hos!t"#

Cr!e$ soon"%ter &!rt',

M"#e, (.) *+,Bre"st %e$ (

e"rs

1) e"rs

Boo*e$ -Immn!/e$0H"$ (

ANC v!s!ts TT IFA2Post "rtm

er!o$ 3 norm"#

G)

FTND,

GovernmentHos!t"#

B"& 4r!e$

soon "%ter

&!rt',

Fem"#e, (*+, Bre"st

%e$ 3 ) 5e"rs

16 e"rs

Boo*e$ -

Immn!/e$0H"$ (ANC v!s!ts TT

IFA2Post "rtm er!o$ 3 norm"#

LMP – 027117200

EDD – 0=70>7200>

PRESENT PREGNANCY

T1

• N h+$& 6 %!'$#!: 9"+&+%/ #!;%#$$.

• N '+%! $"&"$

• N '/ +%&!;#

• N h+$& 6 !9+%/ 6 !%"!, 6 (+!)

T2

• ?'+;#%+%/ +% 5&h "%&h

• 1$& ANC 9+$+& – 20 ##;$: /+9#% TT @ IA &!,#&$ (%$'"#)

T3

• #&!, "9#"#%&$ #$#%&

• N ,#!; ,## PV

• N h7 !+% !"#%



CONTRACEPTIVE HISTORY:

N h+$& 6 '$+%/ !% %&!#&+9# "#&h$.

MENSTRUAL HISTORY:

A/# 6 M#%!h# – 13 #!$

P!$& C,#$ – R#/',! 30 !$ ,#$ +&h 6, ,!$&+%/ 5 !$: %"!, '!%&+&: % !+% !$$+%/ 6

,&$.

LMP – 027117200

FAMILY HISTORY:

N h+$& 6 %/#%+&!, !%"!,+#$ &+%%+%/: DM: HTN

PAST HISTORTY:

N h+$& 6 T'#',$+$: E+,#$: A$&h"!

N h+$& $'//#$&+9# 6 !% !+! !+,"#%&$.

N h+$& 6 #9+'$ $'/#+#$: , &!%$6'$+%$.

PERSONAL HISTORY:

D+#& – M+<#

A#&+&# – G

S,## – S'%

B#, @ B,!# – R#/',!

H!+&$ – N+,

DIET HISTORY:

C%$'"#$ – 2100 ;!,7!R#'+# – 2400 ;!,7!

D#6++& – 300 ;!,7!

GENERAL PHYSICAL EXAMINATION:

H## +$ ! #/%!%& ,! 30 #! ,: "#!&#, '+,& !% %'+$h#: %$+'$: !,#& @ #!&+9#.

P',$# – 847"+%: #/',!: / 9,'"#

BP – 11078 "" 6 H/

RR – 147"+%: #/',!

T#"#!&'# – P!&+#%& +$ !6#+,#

P!,, – P#$#%&

I&#'$ – A$#%&

C!%$+$ – A$#%&

C,'+%/ – A$#%&

E#"! – A$#%&

L"h!#%!&h – A$#%&



Th+ – N"!,

B#!$&$ – N"!,

S+%# – N"!,

H#+/h& – 14 "

#+/h& – 5 ;/

BMI – 2.2>

SYSTEMIC EXAMINATION:

CVS – S1 S2 h#!: N "'"'$.

RS – NVBS h#!: % !$!, #&$.

CNS – NAD.

PA – N"!, #, $'%$ h#!

OBSTETRIC EXAMINATION:

INSPECTION:

• A"#% +$ '%+6", +$&#%#: /,',! +% $h!#• U"+,+'$ #9#&#: h#%+!, +6+#$ %"!,

• ,!%;$ %& !#! & # 6',,

• S&+! /!9+!'" !% ,+%#! %+/! #$#%&

• N $!$ 9# &h# !"#%

PALPATION:

• A"+%!, +'"6##%# – > "

• S"h$+-6'%!, h#+/h& – 28 " (#$%$ & 32 ##;$)

• UNDAL GRIP – S6&: ! @ %%-!,,&!,#: $'//#$&+9# 6 ##h

• L!&#!, G+ – % ,+;# $&'&'#$ % &h# +/h& $+# $'//#$&+9# 6 ,+" '$

U%+6" #$+$&!%# % &h# ,#6& $+# $'//#$&+9# 6 $+%#

•1

ST

PELVIC GRIP – S"&h: h!: !,,&!,# "!$$ $'//#$&+9# 6 h#!• 2ND PELVIC GRIP – +%/#$ %9#/#: h#! %& #%/!/#.

• U&#'$ +$ #,!<#

• #&!, !/# 28F87> 32 ##;$

• #&!, #+/h& (28-12)F155 2480 /"

AUSCULTATION:

• #&!, H#!& $'%$ h#! !,%/ &h# ,#6& $+%-'"+,+!, ,+%#

• 1427"+%: #/',!: h&h"+

DIAGNOSIS:

30 year old G 3P 2 L2 A0 with 32 weeks of gestation, moderate anemia probably due to iron deficiency,

not in labour with no clinical signs of failure.

FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF

2. CASE OF PREGNANCY INDUCED HYPERTENSION (PRE-ECLAMPSIA)

N!"# – N!!!%!""! H'$!%*$ N!"# – Ch!%!!'

A/# – 20 #!$ A/# – 25 #!$

O'!&+% – H'$# +6# O'!&+% – D+9#

A#$$ – D!+ C+,# I%"# – R$.1>007#7"%&h



R#,+/+% – H+%' SE S&!&'$ – U# M+,# C,!$$

D!&# 6 A"+$$+% – 1070>70> D!&# 6 #<!"+%!&+% – 1270>70>

G2P0 A1 "#$ +&h 8 "%&h$ 6 !"#%h#!.

PRESENTING COMPLAINTS: G#%#!,+# ##"! – $+%# 10 !$.

HISTORY OF PRESENTING COMPLAINTS:

• P!&+#%& +$ ! /!9+! 2 !!0 #$#%&$ +&h /#%#!,+# ##"! $+%# 10 !$: +%$++'$ +% %$#&:

+%+&+!,, %&+# +% &h# ,# ,+"$ h+h h!9# /!'!,, /#$$# & +%9,9# &h# '# ,+"$ !%

6!#. I& +$ #$#%& &h'/h'& &h# ! (% +'%!, 9!+!&+%): %& #,+#9# 9#%+/h& #$& % ,+"

#,#9!&+% +% &h# "%+%/.

• N h+$& 6 h#!!h#: ,'+%/ 6 9+$+% $%!, !&&!;$

• N h+$& 6 #'# '+%# '&'&: h#"!&'+!.

• N h+$& 6 h#$& !+%: !,+&!&+%$ #!&h,#$$%#$$ % #<#&+% h+$& $'//#$&+9# 6

!+! 6!+,'#.

• N h+$& 6 #+/!$&+ !+%: %!'$#!: 9"+&+%/.

• N h+$& 6 DM HTN.

• N h+$& 6 !'%+#: !$+&+#$ #6# 20 ##;$ 6 /#$&!&+%.

OBSTETRIC HISTORY:

M!+# L+6# – 2 #!$ (%% – %$!%/'+%'$ "!+!/#)

O$&#&+ +%#< – G2P0 A1

LMP – 0371170

EDD – 1070870>

PREVIOUS PREGNANCY

G1

• P!+%,#$$ $%&!%#'$ !&+% !& &h "%&h 6,,+%/ ,##+%/ PV. P!&+#%& h! /%# 6 4 ANC

9+$+&$: 2 $!%$: ;# !% +""'%+#.• N h+$& 6 #<#$$+9# 9"+&+%/. (Rule out H. mole)

• N h+$& 6 HTN '+%/ #/%!%.

PRESENT PREGNANCY

T1

• M%+%/ $+;%#$$ 6 2 "%&h$ – #$#%&.

• I%#!$# 6#'#% 6 "+&'!&+% – #$#%&.

• N h+$& 6 #!$ 6!&+/'!+,+&.

• N h+$& 6 +$h!/# ,## PV.

• N h+$& 6 '/ +%&!;# !+!&+% #<$'#.

• N h+$& 6 P+!.

T2

• ?'+;#%+%/ !& 5&h "%&h.

• N h+$& 6 h#!!h#: ,'# 9+$+% $'#% +%#!$# +% #+/h&.

• B;# !% I""'%+# – 3 ANC 9+$+&$: 2 TT: 100 IA: S!% %# !& 20 &h ##;.

T3

• #&!, "9#"#%&$ #$#%&.

• N h+$& 6 ,##+%/ +$h!/# PV.

• N h+$& 6 !+% !"#%.



• G#%#!,+# ##"! – #$#%&.

• L!$& !&+% – 1 #! !;.

MENSTRUAL HISTORY:

A/# 6 M#%!h# – 1 #!$

P!$& C,#$ – R#/',!: 30 ! ,#: 4 !$ 6,: % !+% !$$!/# 6 ,&$.

LMP – 0371170

N h+$& 6 !% %&!#&+9#$ '$#.

FAMILY HISTORY: N h+$& 6 DM: HTN: !$&h"!: &+%%+%/ +% 6!"+,. N h+$& 6 PIH +% "&h#

$+$&#.

PAST HISTORTY:

M#+!, – N h+$& $'//#$&+9# 6 DM7HTN.N h+$& 6 TB: #+,#$ !$&h"!.

S'/+!, – N h+$& 6 , &!%$6'$+%$ !% #9+'$ $'/+!, #'#$.

PERSONAL HISTORY:

D+#& – M+<# A#&+&# – G

S,## – S'%

B#, @ B,!# – R#/',!

H!+&$ – N+,


H## +$ ! #/%!%& ,!: "#!&#, '+,& !% %'+$h#: %$+'$: !,#& @ #!&+9# #,, +#%&# &

&+"#: ,!# !% #$%.

P',$# – 87"+%: #/',!: / 9,'"#BP – 147=2 "" 6 H/

RR – 187"+%: #/',!

T#"#!&'# – P!&+#%& +$ !6#+,#

P!,, – P#$#%&

I&#'$ – A$#%&

C!%$+$ – A$#%&

C,'+%/ – A$#%&

E#"! (#!,) – P#$#%&: P+&&+%/ +% %!&'#

L"h!#%!&h – A$#%&

Th+ – N"!,

B#!$&$ – N"!,

S+%# – N"!,

G!+& – N"!,



H#+/h& – 10 "

#+/h& – >0 ;/

BMI – 2>.3


CVS – S1 S2 h#!: % "'"'$.

RS – NVBS h#!: % !+&+%!, $'%$ h#!.

CNS – %## #; – #$#%&. S#%$: "& !% !%+!, %#9#$ – %"!,.

PA – N"!, #, $'%$ h#!


INSPECTION:

• A"#% '%+6", +$&#%#.

• ,!%;$ %& 6',,.

• U"+,+'$ – #9#&#.

• S&+!# /!9+!'": !,+!%$ @ ,+%#! %+/! – #$#%&.

• N $!$ 9# !"#%: % +,!&# 9#+%$.

• H#%+!, +6+#$ – %"!,.

PALPATION: (P!&+#%& #<!"+%# +% $'+%# $+&+% +&h ,#/$ $#"+ 6,#<#).

• '%!, h#+/h& #$%$ & 32 ##;$ /#$&!&+%.

• SH +$ 28 ": !"+%!, +'"6##%# – 85 ".

• '%!, /+ – S"&h: ! +#/',! $&'&'# $'//#$&+9# 6 ##h.

• L!&#!, G+ – R+/h& – % ,+;# $&'&'#$ $'//#$&+9# 6 ,+" '$.

L#6& – U%+6" '9# #$+$&!%# $'//#$&+9# 6 $+%#.

• 1$& P#,9+ G+ – S"&h: '%: h! !,,&!,# "!$$ (%& #%/!/#) $'//#$&+9# 6 h#! 6#,& !&

,# ,#

AUSCULTATION:

• HS h#! !,%/ &h# ,#6& $+%-'"+,+!, ,+%#: "+ +%&.

• R!&# – 147"+%: #/',!.

DIAGNOSIS:

20 year old G 2 A with 32 weeks gestation, single li!e fetus with cephalic presentation with head

not engaged and not in labour, with mild pre"eclampsia #on treatment$ complicating her

pregnancy.


3. CASE OF PREVIOUS LOWER SEGMENT CAESAREAN SECTION

N!"# – A%+&! H'$!%*$ N!"# – V#%;!&#$h

A/# – 23 #!$ A/# – 24 #!$

A#$$ – A&"!&h+%!/!: #%/#+ O'!&+% – P!+%&#

O'!&+% – M!+ $#9!%& I%"# –R$.2007"%&

R#,+/+% – H+%' SE S&!&'$ – L# M+,# C,!$$

D!&# 6 !"+$$+% – 0=70>7200> D!&# 6 #<!"+%!&+% – 1070>7200>

G2P1L1 "#$ +&h = "%&h$ 6 !"#%h#! 6 $!6# %6+%#"#%&




• P!&+#%& "#$ +&h = "%&h$ !"#%h#! +&h ! h+$& 6 #9+'$ LSCS !% !$ !"+&&# 6

$!6# %6+%#"#%&. P!&+#%& h! ##% h## 6 #/',! ANC h#;' % 2>70>7200> !% !$ !$;# &

/#& !"+&&# !$ h# EDD !$ # $!% !$ 1070>7200>.

• P!&+#%& ",!+%&$ 6 !;!h# $+%# &! "%+%/ +% &h# ,# "+-!;: %%-!+!&+%/ !% %&

!$$+!&# +&h !+% !"#%.

•

P!&+#%& /+9#$ h+$& 6 h+&# +$h!/# $+%# 1 ##;: %%-6', $"#,,+%/: %& !$$+!&# +&h 6#9# +&h+%/.

• N h+$& 6 ,#!; PV ,##+%/ PV.

• N h+$& 6 h#"!&'+!.

• N h+$& 6 !% h!%/# +% ,!# h!+&$.

• #&!, "9#"#%&$ !# #,, ##+9#.

• N h+$& 6 D+!#&#$ "#,,+&'$ H#&#%$+%.

OBSTETRIC HISTORY:

M!+# L+6# – 4 #!$ (%% – %$!%/'+%#'$ "!+!/#)

P!+& +%#< – G2P1L1

LMP – 0171170

EDD – 0870870>

PREVIOUS PREGNANCY

T1

• H+$& 6 +%#!$# 9"+&+%/ – #$#%&.

• H+$& 6 #!$ 6!&+/!+,+&.

• N h+$& 6 '+%! $"&"$.

• N h+$& 6 '/ +%&!;# !+!&+% #<$'#.

• N h+$& 6 +!.

T2

• ?'+;#%+%/ !& 20&h ##;.

• H+$& 6 /#%#!,+# ##"! – #$#%&.• N h+$& 6 h#!!h# ,'+%/ 6 9+$+%.

• P!&+#%& !$ ;# !% +""'%+# – ANC h#;'$: 2 USG $!%$: 2 TT @ 100 IA.

T3

• #&!, "9#"#%&$ #$#%&.

• U%#9#%&6',.

• D#,+9## L# S#/"#%& C!#$!#!% S#&+% !, '# & $&'&# ,!' %%-

/#$$+% 6 ,!'.

• P!&+#%& !$ +%+&+!,, '& % &+!, 6 ,!' !"+%+$&#+%/ +%#&+%$: '& $+%# ,!' !+%$ ##

%& !#'!&#: $h# !$ $&# 6 #"#/#% LSCS: !6&# +%6'$+%/ 1 '%+& 6 ,.

• O'&"# !$ ! ,+9# "!,# 6#&'$: 3.> ;/ !& +&h: !$ +""'%+# !% #<,'$+9#, #!$& 6# 6 1

#!.• M&h# h! % 6#9# '% +$h!/# +% &h# $&- #+.

• S'&'#$ ## #"9# % &h# >&h ! '& h! & $&! +% &h# h$+&!, 6 1 !$ !$ &h# ! h!

!'%+#.

• L!$& C-$#&+% – 3 #!$ !; (A+, 25&h: 2004)

PRESENT PREGNANCY: T1: T2 !% T3 '%#9#%&6',. EDD-0870870>

CONTRACEPTIVE HISTORY:

N h+$& 6 '$+%/ !% %&!#&+9# "#&h$.



MENSTRUAL HISTORY:

A/# 6 M#%!h# – 12 #!$

P!$& C,#$ – R#/',!: 50->0 ! ,#: 8-= !$ 6,: % !+% !$$!/# 6 ,&$.

LMP – 0171170

N h+$& 6 !% %&!#&+9#$ '$#.

FAMILY HISTORY: N h+$& 6 DM: HTN.

PAST HISTORTY:

M#+!, – N h+$& $'//#$&+9# 6 DM7HTN. N h+$& 6 TB: #+,#$ !$&h"!.

S'/+!, – N h+$& 6 , &!%$6'$+%$ !% #9+'$ $'/+!, #'#$.

PERSONAL HISTORY:

D+#& – M+<#

A#&+&# – G

S,## – S'%

B#, @ B,!# – R#/',!

H!+&$ – N+,


M&h# +$ ! '%/ ,!: "#!&#, '+,& !% %'+$h#: %$+'$: !,#& @ #!&+9# #,, +#%&# &

&+"#: ,!# !% #$%.

P',$# – >87"+%: #/',!: / 9,'"#

BP – 11782 "" 6 H/

RR – 187"+%: #/',!

T#"#!&'# – P!&+#%& +$ !6#+,#

P!,, – P#$#%&

I&#'$ – A$#%&

C!%$+$ – A$#%&

C,'+%/ – A$#%&

E#"! – A$#%&

L"h!#%!&h – A$#%&

Th+ – N"!,

B#!$&$ – N"!,S+%# – N"!,

G!+& – N"!,

H#+/h& – 158 "

#+/h& – 51 ;/




CVS – S1 S2 h#!: N "'"'$.

RS – NVBS h#!: % !$!, #&$.

CNS – NAD.

PA – NAD


INSPECTION:

• D+$&#%# !% 6,!%;$ !# 6',,.

• U"+,+'$ – %"!,.

• S&+!# /!9+!'": !,+!%$ @ ,+%#! %+/! – #$#%&.

• N +,!&# 9#+%$.

• H#%+!, +6+#$ – %"!,.

• A 9#&+!, +/h& !!"#+!% +%+$+%: 14 " ,%/ +$ $##% +% &h# +%6!-'"+,+!, #/+%: h#!,#

+"! +%&#%&+% – % h#&h ;#+,+ 6"!&+%: % $'!-'+ ',/#.

PALPATION: (P!&+#%& #<!"+%# +% $'+%# $+&+% +&h ,#/$ $#"+ 6,#<#).

• '%!, h#+/h& #$%$ & 32 ##;$ +&h 6,!%;$ 6',, – #$%+%/ & 40 ##;$ 6 /#$&!&+%.

• SH +$ 32".

• '%!, /+ – B!: $6& +#/',! $&'&'# $'//#$&+9# 6 ##h.• L!&#!, G+ – R+/h& – % ,+;# $&'&'#$ $'//#$&+9# 6 L+" '$.

L#6& – U%+6" '9# #$+$&!%# $'//#$&+9# 6 $+%#.

• 1$& P#,9+ G+ – S"&h: h! !,,&!,# "!$$.

• 2% P#,9+ G+ – +%/#$ +9#/#.

• A"+%!, /+&h – =5 ".

• #+/h& 6 &h# 6#&'$ (Jh%$%*$ 6"',!) 320 /".

• A/# 6 6#&'$ (M D%!,*$ 6"',!) 40 ##;$.

• N $! &#%#%#$$.

• N $'!-'+ ',/# 6#,&.

AUSCULTATION:

• HS h#! !,%/ &h# ,#6& $+%'"+,+!, ,+%#: "+ +%&.• R!&# – 1407"+%: #/',!.

DIAGNOSIS:

23 year old G 2 P L with full term single intrauterine pregnancy with pre!ious L%&% with

longitudinal lie with cephalic presentation not in labour.


. CASE OF R! NEGATIVE PREGNANCY

N!"# – S!9+&! H'$!%*$ N!"# – S!&+$hh!%!

A/# – 24 #!$ A/# – 28 #!$

O'!&+% – H'$# +6# O'!&+% – C,#; A#$$ – Ch!"!#& I%"# – R$. 10007#$%7"%&h

SE S&!&'$ – L# M+,# C,!$$

D!&# 6 A"+$$+% – 0>70>70> D!&# 6 #<!"+%!&+% – 1170>70>

G2P1L "#$ +&h > "%&h$ 6 !"#%h#! 6 $!6# %6+%#"#%&.

HISTORY OF PRESENTING COMPLAINTS



• P!&+#%& "#$ +&h > "%&h$ !"#%h#! 6 $!6# %6+%#"#%&. P!&+#%& h! ##% h## 6

#/',! ANC h#;' % 5&h J', !% !$ !9+$# & /#& !"+&&# &#,,+%/ h# &h!& h# , /' #$

%& "!&h +&h &h!& 6 h# ! (&, & h# ! +9!&# !&+&+%#).

• N h+$& 6 /#%#!,+# #!;%#$$ !% /++%#$$

• N h+$& 6 h#!!h#: ,'# 9+$+% ##!$# "+&'+&+%

•

N h+$& 6 ##"! !% '+&+$.• N &h# $$&#"+ ",!+%&$.

OBSTETRIC HISTORY:

M!+# L+6# – 4 #!$ (%% – %$!%/'+%#'$ "!+!/#)

O$&#&+ +%#< – G2P1L0 A0D1

LMP – 0471270

EDD – 1170870>

PREVIOUS PREGNANCY

• TD !& h"#: +# $% !6&# +&h: #+/h& %& "#!$'#.

• B;# @ I""'%+#: 5 ANC 9+$+&$: 2 TT @ 100 IA.

• Th# ! +# 2 !$ !6&# +&h '# & '%;%% #!$%$.

PRESENT PREGNANCY

T1

• M%+%/ $+;%#$$ 6 2 "%&h$.

• N h+$& 6 U+%! $"&"$.

• N h+$& 6 D'/ +%&!;#.

• N h+$& 6 P+!.

T2

• ?'+;#%+%/ !& 20&h ##;.

• N h+$& 6 h#!!h#: ,'# 9+$+%.

• 2 ANC 9+$+&$: 2 TT: 100 IA: 2 $!%$.

T3

• #&!, "9#"#%&$ #$#%&.

• N ,##+%/7,#!; PV.

• I% &h+$ #/%!%: $h# !$ #9!,'!&# @ h# , /' &'%# '& & # B –9# h+,# &h!& 6 &h#

6#&'$ !$ O K9#

• N A%&+ – D +%#&+% /+9#%.

• N h+$& 6 !&+%: LSCS IUD +%9!$+9# 6#&!, #'#.

• P#9+'$ ! , /' %& ;%%.

• L!$& #,+9# – 2 #!$ !;.

CONTRACEPTIVE HISTORY

N h+$& 6 '$+%/ !% %&!#&+9# "#&h$.

MENSTRUAL HISTORY:

A/# 6 M#%!h# – 15 #!$

P!$& C,#$ – R#/',!: 30 ! ,#: 4 !$ 6,: % !+% !$$!/# 6 ,&$.

LMP – 0471270

FAMILY HISTORY: N h+$& 6 DM: HTN.



PAST HISTORTY:

M#+!, – N h+$& $'//#$&+9# 6 DM7HTN. N h+$& 6 TB: #+,#$ !$&h"!.

S'/+!, – N h+$& 6 , &!%$6'$+%$ !% #9+'$ $'/+!, #'#$.

PERSONAL HISTORY:

D+#& – M+<#

A#&+&# – G

S,## – S'%

B#, @ B,!# – R#/',!

H!+&$ – N+,

GENERAL PHYSICAL EXAMINATION

M&h# +$ ! 24 #! , ,!: "#!&#, '+,& !% %'+$h#: %$+'$: !,#& @ #!&+9#.

P',$# – 827"+%: #/',!: / 9,'"#

BP – 120750 "" 6 H/

RR – 187"+%: #/',!

T#"#!&'# – A6#+,#

P!,, – A$#%&

I&#'$ – A$#%&

C!%$+$ – A$#%&

C,'+%/ – A$#%&

E#"! – A$#%&

L"h!#%!&h – A$#%&

Th+ – N"!,

B#!$&$ – N"!,

S+%# – N"!,

G!+& – N"!,

H#+/h& – 15 "

#+/h& – 0 ;/

SYSTEMIC EXAMINATION

CVS – S1 S2 h#!: N "'"'$.RS – NVBS h#!: % !$!, #&$.

CNS – NAD.

PA – NAD

OBSTETRIC EXAMINATION

INSPECTION

• A"#% '%+6", +$&#%#.

• ,!%;$ %& 6',,.



• U"+,+'$ – %"!,.

• S&+!# /!9+!'": !,+!%$ @ ,+%#! %+/! – #$#%&.

• N $!$ 9# !"#%: % +,!&# 9#+%$.

• H#%+!, +6+#$ – %"!,.

PALPATION (P!&+#%& #<!"+%# +% $'+%# $+&+% +&h ,#/$ $#"+ 6,#<#).

•

'%!, h#+/h& #$%$ & 28 ##;$ /#$&!&+%.• SH +$ 25 ".

• '%!, /+ – S"&h: ! +#/',! $&'&'# $'//#$&+9# 6 ##h.

• L!&#!, G+ – R+/h& – % ,+;# $&'&'#$ $'//#$&+9# 6 L+" '$.

L#6& – U%+6" '9# #$+$&!%# $'//#$&+9# 6 $+%#.

• 1$& P#,9+ G+ – S"&h: '%: h! !,,& !,# "!$$ (%& #%/!/#) $'//#$&+9# 6 H#! 6#,& !&

,# ,#.

AUSCULTATION

• HS h#! !,%/ &h# ,#6& $+%'"+,+!, ,+%#: "+ +%&.

• R!&# – 1407"+%: #/',!.

DIAGNOSIS

22 year old G 2 P Lo with ' months amenorrhea, single li!e fetus, not in labour with (h )!e pregnancy.


". CASE OF HEART DISEASE IN PREGNANCY # 1

N!"# – Ch!%!;!,! H'$!%*$ N!"# – M!%'%!&h

A/# – 32 #!$ A/# – 35 #!$

A#$$ – Ch+;!!,,!' O'!&+% – C,&h "#h!%&

O'!&+% – H'$#+6# I%"#–R$.20007"%&h

R#,+/+% – H+%' SE S&!&'$ – U# M+,#

D!&# !"+$$+% – 1270>7200> D!&# 6 #<!"+%!&+%– 1270>7200>

G3P1L1 A1 "#$ +&h = "%&h$ 6 !"#%h#! 6 $!6# %6+%#"#%& 6 #,+9#.


• P!&+#%& "#$ +&h = "%&h$ !"#%h#! 6 $!6# %6+%#"#%& +&h ! h+$& 6 !+! $'/#.

• N h+$& 6 #!&h,#$$%#$$ % #<#&+%: !,+&!&+%$: h#$& !+%: PND: &h%#!: ##"! 6

6##&.

• N h+$& 6 !% %/#%+&!, h#!& +$#!$#.

• N h+$& $'//#$&+9# 6 CC: +%6#&+9# #%!+&+$ +% &h# !$& #$#%& #/%!%.

OBSTETRIC HISTORY:

M!+# L+6# – 1 #!$ (%% – %$!%/'+%#'$ "!+!/#)

O$&#&+ +%#< – G3P1L1 A1

LMP – 1571070

EDD – 2270>70>

PREVIOUS PREGNANCY:

G1 – TND: G9#%"#%& H$+&!,: N 11 #!$: C+# $% !6&# +&h: #+/h# 3 ;/: P$& !&'"

#+ %"!,: B;# !% +""'%+#: 3 ANC 9+$+&$: 2TT @ 100 IA ##+9#.



G2 – A&# !& 1 "%&h$ /#$&!&+% (MTP) #!$ !/.

PRESENT PREGNANCY:

T1

• H+$& 6 %!'$#! !% 9"+&+%/.

• N h+$& 6 '+%! $"&"$.

• N h+$& 6 '/ +%&!;# !+!&+% #<$'#.• N h+$& 6 +!.

T2

• ?'+;#%+%/ !& 18&h ##;.

• N h+$& 6 h#!!h# ,'+%/ 6 9+$+% ##"!.

• P!&+#%& !$ ;# !% +""'%+# – 4 ANC h#;'$: 2 TT @ 100 IA.

T3

• I%#!$# 6#'#% 6 "+&'I&+% – #$#%&.

• #&!, "9#"#%&$ #$#%&.

• U%#9#%&6',.


N h+$& 6 '$+%/ !% %&!#&+9# "#&h$.

MENSTRUAL HISTORY

A/# 6 M#%!h# – 15 #!$

P!$& C,#$ – R#/',!: 30 ! ,#: 3 !$ 6,: % !+% !$$!/# 6 ,&$.

LMP – 1571070

FAMILY HISTORY: N h+$& 6 DM: HTN. N h+$& 6 !% %/#%+&!, h#!& +$#!$# !"%/ #,!&+9#$.

PAST HISTORTY

• P!&+#%& '%##%& ! !+! $'/# 2 #!$ !; h#% $h# #9#,# $'#% %$#& 6

#!&h,#$$%#$$ &h'/h $h# !$ % "#+!, &#!&"#%& 6 $"# !+! !+,"#%& 6 5 #!$. H##9+'$ #&$ #9#!,# &h!& $h# !$ +!/%$# & h!9# RSOV +&h VSD. Sh# '%##%& &h#

#!&+% +% ! /9#%"#%& h$+&!, +% P'&!&+.

• N h+$& 6 6,##&+%/ +%& !+%$ 6#9# +% &h# h+,h !% !&+#%& %& % #%+'# h,!<+$.

• N h+$& 6 !% $&- ",+!&+%$.

• N h+$& $'//#$&+9# 6 DM HTN.

• N h+$& 6 TB: #+,#$ !$&h"!.

PERSONAL HISTORY:

D+#& – M+<#

A#&+&# – G

S,## – S'%

B#, @ B,!# – R#/',!

H!+&$ – N+,


H## +$ ! #/%!%& ,!: "#!&#, '+,& !% %'+$h#: %$+'$: !,#& @ #!&+9# #,, +#%&# &

&+"#: ,!# !% #$%.



P',$# – =07"+%: #/',!: / 9,'"#: %"!, h!!&#: !,, PP 6#,&. JVP – %"!,

BP – 1307>0 "" 6 H/

RR – 187"+%: #/',!: TA

T#"#!&'# – A6#+,#

P!,, – A$#%&

I&#'$ – A$#%&

C!%$+$ – A$#%&

C,'+%/ – A$#%&

E#"! – A$#%&

L"h!#%!&h – A$#%&

Th+ – N"!,

B#!$&$ – N"!,

S+%# – N"!,

G!+& – N"!,

H#+/h& – 10 "

#+/h& – 0 ;/

SYSTEMIC EXAMINATION

CARDIO-VASCULAR SYSTEM

INSPECTION

• N #+!, ',/#.

• A+!, +"',$# – ,#6& 4&h +%&#-$&!, $!#: 2 " ,!&#!, & M+-!9+',! ,+%#.

• N &h# !%"!, ',$!&+%$.

• A ,+%#! $! $##% 9# &h# "+-$&#%'" 15 " 2 ".

• N +,!&# 9#+%$ 9# &h# h#$& !,,.

PALPATION

• I%$#& 6+%+%/$ ## %6+"#.

• A#< #!& – ,#6& 4&h +%&#-$&!, $!#: 2 " ,!&#!, & M+-!9+',! ,+%#.

• N !!$&#%!, h#!9#.

• N &h+,, 6#,&.

• N !%"!, ',$!&+%$.

AUSCULTATION

CVS

Aortic area

S1S) 'e"r$, no mrmrs.

Pulmonary area

Mitral area

Tricuspid area



RS – NVBS h#!: % !$!, #&$.

CNS – NAD.

PA – NAD


INSPECTION:

• A"#% +$ +$&#%#: 6,!%;$ !# 6',,.• U"+,+'$ – %"!,.

• S&+!# /!9+!'": !,+!%$ @ ,+%#! %+/! – #$#%&.

• N +,!&# 9#+%$ $!$ $+%'$#$.

• H#%+!, +6+#$ – %"!,.

PALPATION: (P!&+#%& #<!"+%# +% $'+%# $+&+% +&h ,#/$ $#"+ 6,#<#).

• '%!, h#+/h& #$%$ & 32 ##;$ +&h 6,!%;$ 6',, – #$%+%/ & 40 ##;$ 6 /#$&!&+%.

• Sh#,9+%/ S+/% – $+&+9#.

• S"h$+$ – 6'%!, h#+/h& +$ 30 ".

• '%!, /+ – B!: $6&: %%-!,,&!,#: #,!&+9#, ,!/# +#/',! $&'&'# $'//#$&+9# 6 ##h.

• L!&#!, G+ – R+/h& – % ,+;# $&'&'#$ $'//#$&+9# 6 L+" '$.

L#6& – U%+6" '9# #$+$&!%# $'//#$&+9# 6 $+%#.• 1$& P#,9+ G+ – S"&h: h! !,,&!,# "!$$ #,!&+9#, $"!,, 6#,& $'//#$&+9# 6 h#!.

• A"+%!, /+&h – 104 ".

• #+/h& 6 6#&'$ (Jh%$%*$ 6"',!) – 2800 /".

• A/# 6 6#&'$ (M D%!,*$ 6"',!) – 40 ##;$.

AUSCULTATION:

• HS h#! !,%/ &h# ,#6& $+%'"+,+!, ,+%#: "+ +%&.

• R!&# – 1407"+%: #/',!.

DIAGNOSIS

32 year old G 3P L A with full term pregnancy with cephalic presentation, not in labour with a

pre!ious history of cardiac surgery.


$. CASE OF HEART DISEASE IN PREGNANCY # 2

N!"# – !+! T! H'$!%*$ N!"# – R#h"!%

A/# – 25 #!$ A/# – 30 #!$

A#$$ – Ch+;!!,,!' O'!&+% – P,!$&+ I&#"$ $#,,#

O'!&+% – ;# +% A/!!&&+ 6!& I%"#–R$.30007"%&h

R#,+/+% – H+%' SE S&!&'$ – U# M+,# C,!$$

D!&# 6 !"+$$+% – 087117200> D!&# 6 #<!"+%!&+% – 217117200>

P+"+/!9+! "#$ +&h = "%&h$ 6 !"#%h#!

PRESENTING COMPLAINTS

• P!+% !"#% – 13 !$.

• S#,,+%/ 6 &h ,# ,+"$ – 13 !$.

• Ch#$& !+% !% #!&h,#$$%#$$ – 8 !$.




• P!&+#%& /+9#$ h+$& 6 !+% !"#% 6 &h# !$& 13 !$: 9# &h# ,# !& 6 &h# !"#%:

"#!&# +%&#%$+&: +%&#"+&&#%& +% %!&'#: #!h #+$# ,!$&+%/ !'& 2 h'$ !% !<+"!&#, 2-3

#+$#$ # !: #,+9# % "#+!&+%.

• P!&+#%& !,$ ",!+%&$ 6 $#,,+%/ 6 &h &h# ,# ,+"$ $+%# 13 !$: +%$++'$ +% %$#&:

+%+&+!,, #$#%& 9# &h# 6##& !% h!$ /!'!,, /#$$# & &h# ;%##: #$#%& &h'/h'& &h# !:

+%#!$#$ % !,;+%/ !% #,+9# % &!;+%/ #$&. N +'%!, 9!+!&+%. N h+$& 6 +$&#%&+% 6!"#% '66+%#$$ 6 6!#.

• P!&+#%& !,$ /+9#$ ! h+$& 6 h#$& !+% $+%# ,!$& 8 !$: $'#% +% %$#&: 9# &h# #&$&#%!,

#/+%: /#$$+9#: %$&+&+%/ &#: %%-!+!&+%: "#!&# $#9#+&: !//!9!&# % #<#&+% !%

#,+#9# % #$&. I& +$ !$$+!&# +&h #!&h,#$$%#$$: +%$++'$ +% %$#&: /#$$+9# +% %!&'#: +%+&+!,,

!&+#%& !$ !,# & h# '&+%# !&+9+&+#$ '& % $h# /#&$ #!&h,#$$ !6&# !,;+%/ ! 6# "#&#$. I&

+$ #,+#9# % #$&.

• H+$& 6 !,+&!&+%$ #$#%&.

• N h+$& 6 ,##+%/ +$h!/# # 9!/+%!.

• N h+$& 6 &h%#!: PND.

• N h+$& $'//#$&+9# 6 CC: I%6#&+9# #%!+&+$.

• N h+$& 6 6#9#.

• N h+$& $'//#$&+9# 6 &h+ +$#!$#.

• N h+$& 6 !% !+! +$#!$#

• N& ! ;%% !$# 6 DM HTN.

OBSTETRIC HISTORY:

M!+# L+6# – 1 #!$ (%% – %$!%/'+%#'$ "!+!/#)

P!+& +%#< – +"+/!9+!

LMP – 0370370>

EDD – 1071270>

PRESENT PREGNANCY:

T1

• H+$& 6 %!'$#! !% 9"+&+%/.

• H+$& 6 '+%! $"&"$ – #$#%&.

• N h+$& 6 '/ +%&!;# !+!&+% #<$'#.

• N h+$& 6 +!: B;# !% I""'%+#.

T2

• ?'+;#%+%/ !& 5&h "%&h.

• N h+$& 6 h#!!h# ,'+%/ 6 9+$+% ##"!.

T3

• #&!, "9#"#%&$ #$#%&.

• D#9#,# $#,,+%/ 6 &h ,# ,+"$: h#$& !+% !% #!&h,#$$%#$$ !$ "#%&+%# #9+'$,.


N h+$& 6 '$+%/ !% %&!#&+9# "#&h$.

MENSTRUAL HISTORY:



A/# 6 M#%!h# – 15 #!$

P!$& C,#$ – R#/',!: 30 ! ,#: 3 !$ 6,: % !+% !$$!/# 6 ,&$.

LMP – 0370370>

FAMILY HISTORY N h+$& 6 DM: HTN. N h+$& 6 !% %/#%+&!, h#!& +$#!$# !"%/ #,!&+9#$.

PAST HISTORTY

• N h+$& 6 6,##&+%/ +%& !+%$ 6#9# +% &h# h+,h !% !&+#%& %& % #%+'# h,!<+$.

• N h+$& $'//#$&+9# 6 !% &h# %/#%+&!, h#!& +$#!$#.

• N h+$& 6 h#!& $'/#.

• N h+$& $'//#$&+9# 6 DM HTN.

• N h+$& 6 TB: #+,#$ !$&h"!.

• N h+$& 6 #9+'$ h$+&!,+!&+% &#!&"#%& 6 h#!& !+,"#%&$.

PERSONAL HISTORY

D+#& – M+<#

A#&+&# – G

S,## – S'%

B#, @ B,!# – R#/',!

H!+&$ – N+,


M&h# +$ ! '%/ ,!: "#!&#, '+,& !% %'+$h#: %$+'$: !,#& @ #!&+9# #,, +#%&# &

&+"#: ,!# !% #$%.

P',$# – ==7"+%: #/',!: / 9,'"#: %"!, h!!&#: !,, PP 6#,&. JVP– !+$# ( ").

BP – 127=0 "" 6 H/ +% ,#6& '# ,+" +% $'+%# $+&+%.

RR – 187"+%: #/',!: TA

T#"#!&'# – P!&+#%& +$ !6#+,#

P!,, – A$#%&

I&#'$ – A$#%&

C!%$+$ – A$#%&

C,'+%/ – A$#%&

E#"! – A$#%&

L"h!#%!&h – A$#%&

Th+ – N"!,

B#!$&$ – N"!,

S+%# – N"!,

G!+& – N"!,

H#+/h& – 10 "

#+/h& – 0 ;/




CARDIO-VASCULAR SYSTEM:

INSPECTION

• N #+!, ',/#.

• A+!, +"',$# – ,#6& 4&h +%&#-$&!, $!#: 2 " ,!&#!, & M+-!9+',! ,+%#.

• N &h# !%"!, ',$!&+%$.• N +,!&# 9#+%$ 9# &h# h#$& !,,: % $!$.

PALPATION

• I%$#& 6+%+%/$ ## %6+"#.

• A#< #!& – ,#6& 4&h +%&#-$&!, $!#: 2 " ,!&#!, & M+-!9+',! ,+%#.

• P!!$&#%!, h#!9# – #$#%&.

• N &h+,, 6#,&.

• N !%"!, ',$!&+%$.

AUSCULTATION

CVS

Aort!4 "re" S1 #o$, S) 'e"r$ , No mrmrs

P#mon"r "re" ESM 3 resent

M!tr"# "re" MDM 3 resent

Tr!4s!$ "re" S1S) 'e"r$, No mrmrs

RS – NVBS h#!: % !$!, #&$.

CNS – NAD.

PA – NAD


INSPECTION:

• A"#% +$ +$&#%#: 6,!%;$ !# 6',,.

• U"+,+'$ – %"!,.

• S&+!# /!9+!'": !,+!%$ @ ,+%#! %+/! – #$#%&.

• N +,!&# 9#+%$ $!$ $+%'$#$.

• H#%+!, +6+#$ – %"!,.

PALPATION:

• A"+%!, +'"6##%# – > "

• S"h$+-6'%!, h#+/h& – 28 " (#$%$ & 32 ##;$)

• UNDAL GRIP – S6&: ! @ %%-!,,&!,#: $'//#$&+9# 6 B##h

• L!&#!, G+ – % ,+;# $&'&'#$ % &h# +/h& $+# $'//#$&+9# 6 ,+" '$

U%+6" #$+$&!%# % &h# ,#6& $+# $'//#$&+9# 6 $+%#

• 1ST PELVIC GRIP – S"&h: h!: !,,&!,# "!$$ $'//#$&+9# 6 h#!

• 2ND PELVIC GRIP – +%/#$ %9#/#: h#! %& #%/!/#.

• U&#'$ +$ #,!<#

AUSCULTATION:

• HS h#! !,%/ &h# ,#6& $+%'"+,+!, ,+%#: "+ +%&.

• R!&# – 1407"+%: #/',!.

DIAGNOSIS



2* year old primi with full term pregnancy with cephalic presentation not in labour with cardiac

disease #!al!ular lesion$, probably (+, -% in sinus rhythm, not in failure with no e!idence of

infecti!e endocarditis.

L!+%/...

3 responses to “CLINICAL CASES (OBSTETRICS)”

1.

A%!&

M! 2: 2011 !& 815 "

$'# $&'66 9# h#,6', &

R#,

2.

'*

J!%'! 10: 2013 !& 1222 !"

&h!%;$ ! ,& $+. +& 9# h#,6',.

R#,

3.

H%+

J'%# 13: 2013 !& 1118 "

E<#,,#%& ;..#!,, '$#6', &..

R#,

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