Obstetrics n Gynaecology MADE EASY COMPILED BY DR.DEEVISH N D HOME ABOUT CLINICAL CASES (GYNAECOLOGY (GYNAECOLOGY)) CLINICAL CASES (OBSTETRICS (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! V!$!%&h!""! $!%&h!""! A/# – 30 #!$ A#$$ – N#,!"!%/!,! N#,!"!%/!,! O'!&+% – H'$#+6# R#,+/+% – H+%'
H'$!%*S N!"# – B!+,!%!! A/# – 35 #!$ #!$ O'!&+% – C,+# C,+# I%"# – R$. 33007"%&h SE S&!&'$ – U# L# ,!$$
G3P2L2 "#$ +&h 8 "%&h$ 6 !"#%h#! PRESENTING COMPLAINTS – COMPLAINTS – E!$ 6!&+/!+,+& $+%# 2 "%&h$ HISTORY OF PRESENTING COMPLAINTS: P!&+#%& #$#%&$ +&h 8 "%&h$ 6 !"#%h#! +&h #!$ 6!&+/!+,+& 6!&+/!+,+& $+%# 2 "%&h$. P#9+'$, P#9+'$,::
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• • •
&h# !&+#%& !$ !,# & h# h'$#h, ;: '& 6 &h# !$& 2 "%&h$: $h# /#&$ &+# #9#% +&h "+%+"!, ;. O% !,;+%/ !'& 50 ": !&+#%& ",!+%$ 6 6!&+/!+,+&: 6!&+/!+,+&: /++%#$$: ,'+%/ ,'+%/ 6 9+$+% h+h +$ #,+9# % #$&. N h+$& 6 +%#!$# ,##+%/ '+%/ "#%$#$ + & #/%!%. N h+$& 6 #<#&+%!, $%#!: !,+&!&+%: PND: #!, ##"! /++%#$$. N h+$& 6 ,##+%/ ,#!; PV.
N h+$& 6 ,##+%/ PR "!,#%!. N h+$& 6 !$$+%/ "$ +% &h# $&,$. N h+$& 6 6#9# +&h h+,,$ !% '%+%/ "+&'!&+%. N h+$& 6 '/h +&h #<#&!&+%: h#"&$+$: #9#%+%/ +$# 6 &#"#!&'# %&!& +&h !
• • • •
• • •
;%% !$# 6 &'#',$+$. N h+$& 6 '/ +%&!;# (!%&+-"!,!+!, '/$ !$++%). N h+$& 6 !% #,,+$h +$,'!&+% +$,'!&+% 6 $;+% !% $,#!. N& ! ;%% +!#&+ h#&#%$+9#.
OBSTETRIC HISTORY HISTORY:: M!+# L+6# – 13 #!$: N%-%$!%/'+%'$ O$&#&+ +%#< – G 3P2L2
No .
G1
G)
DELIVERY
BABY AT BIRTH
FTND, Government Hos!t"#
Cr!e$ soon "%ter &!rt', M"#e, (.) *+, Bre"st %e$ ( e"rs
FTND, Government Hos!t"#
B"& 4r!e$ soon "%ter &!rt', Fem"#e, ( *+, Bre"st %e$ 3 ) 5 e"rs
PRESENT AGE
1) e"rs
16 e"rs
LMP – 027117200 EDD – 0=70>7200> PRESENT PREGNANCY T1 • • • •
N h+$& 6 %!'$#!: 9"+&+%/ #!;%#$$. N '+%! $"&"$ N '/ +%&!;# N h+$& 6 !9+%/ 6 !%"!, 6 (+!)
T2 • •
?'+;#%+%/ +% 5&h "%&h 1$& ANC 9+$+& – 20 ##;$: /+9#% TT @ IA &!,#&$ (%$'"#)
T3 • • •
#&!, "9#"#%&$ #$#%& N ,#!; ,## PV N h7 !+% !"#%
COMMENTS
Boo*e$ Immn!/e$0H"$ ( ANC v!s!ts TT IFA2Post "rtm er!o$ 3 norm"#
Boo*e$ Immn!/e$0H"$ ( ANC v!s!ts TT IFA2Post "rtm er!o$ 3 norm"#
CONTRACEPTIVE HISTORY: N h+$& 6 '$+%/ !% %&!#&+9# "#&h$. MENSTRUAL HISTORY: A/# 6 M#%!h# – 13 #!$ P!$& C,#$ – R#/',! 30 !$ ,#$ +&h 6, ,!$&+%/ 5 !$: %"!, '!%&+&: % !+% !$$+%/ 6 ,&$. LMP – 027117200 FAMILY HISTORY: N h+$& 6 %/#%+&!, !%"!,+#$ &+%%+%/: DM: HTN PAST HISTORTY: N h+$& 6 T'#',$+$: E+,#$: A$&h"! N h+$& $'//#$&+9# 6 !% !+! !+,"#%&$. N h+$& 6 #9+'$ $'/#+#$: , &!%$6'$+%$. PERSONAL HISTORY: D+#& – M+<# A#&+&# – G S,## – S'% B#, @ B,!# – R#/',! H!+&$ – N+, DIET HISTORY: C%$'"#$ – 2100 ;!,7! R#'+# – 2400 ;!,7! D#6++& – 300 ;!,7! GENERAL PHYSICAL EXAMINATION: H## +$ ! #/%!%& ,! 30 #! ,: "#!&#, '+,& !% %'+$h#: %$+'$: !,#& @ #!&+9#. P',$#
– 847"+%: #/',!: / 9,'"#
BP
– 11078 "" 6 H/
RR
– 147"+%: #/',!
T#"#!&'#
– P!&+#%& +$ !6#+,#
P!,,
– P#$#%&
I&#'$
– A$#%&
C!%$+$
– A$#%&
C,'+%/
– A$#%&
E#"!
– A$#%&
L"h!#%!&h
– A$#%&
Th+
– N"!,
B#!$&$
– N"!,
S+%#
– N"!,
H#+/h&
– 14 "
#+/h&
– 5 ;/
BMI
– 2.2>
SYSTEMIC EXAMINATION: CVS – S1 S2 h#!: N "'"'$. RS – NVBS h#!: % !$!, #&$. CNS – NAD. PA – N"!, #, $'%$ h#! OBSTETRIC EXAMINATION: INSPECTION: A"#% +$ '%+6", +$&#%#: /,',! +% $h!# U"+,+'$ #9#&#: h#%+!, +6+#$ %"!, ,!%;$ %& !#! & # 6',, S&+! /!9+!'" !% ,+%#! %+/! #$#%& N $!$ 9# &h# !"#%
• • • • •
PALPATION: A"+%!, +'"6##%# – > " S"h$+-6'%!, h#+/h& – 28 " (#$%$ & 32 ##;$) UNDAL GRIP – S6&: ! @ %%-!,,&!,#: $'//#$&+9# 6 ##h L!&#!, G+ – % ,+;# $&'&'#$ % &h# +/h& $+# $'//#$&+9# 6 ,+" '$
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• • • • •
U%+6" #$+$&!%# % &h# ,#6& $+# $'//#$&+9# 6 $+%# 1ST PELVIC GRIP – S"&h: h!: !,,&!,# "!$$ $'//#$&+9# 6 h#! 2ND PELVIC GRIP – +%/#$ %9#/#: h#! %& #%/!/#. U&#'$ +$ #,!<# #&!, !/# 28F87> 32 ##;$ #&!, #+/h& (28-12)F155 2480 /"
AUSCULTATION: #&!, H#!& $'%$ h#! !,%/ &h# ,#6& $+%-'"+,+!, ,+%# 1427"+%: #/',!: h&h"+
• •
DIAGNOSIS: 30 year old G 3P 2 L A 2 0 with 32 weeks of gestation, moderate anemia probably due to iron deficiency, not in labour with no clinical signs of failure. FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF 2. CASE OF PREGNANCY INDUCED HYPERTENSION (PRE-ECLAMPSIA) N!"# – N!!!%!""! A/# – 20 #!$ O'!&+% – H'$# +6# A#$$ – D!+ C+,#
H'$!%*$ N!"# – Ch!%!!' A/# – 25 #!$ O'!&+% – D+9# I%"# – R$.1>007#7"%&h
R#,+/+% – H+%'
SE S&!&'$ – U# M+,# C,!$$
D!&# 6 A"+$$+% – 1070>70>
D!&# 6 #70>
G2P 0A1 "#$ +&h 8 "%&h$ 6 !"#%h#!. PRESENTING COMPLAINTS: G#%#!,+# ##"! – $+%# 10 !$. HISTORY OF PRESENTING COMPLAINTS: P!&+#%& +$ ! /!9+! 2 !!0 #$#%&$ +&h /#%#!,+# ##"! $+%# 10 !$: +%$++'$ +% %$#&:
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+%+&+!,, %&+# +% &h# ,# ,+"$ h+h h!9# /!'!,, /#$$# & +%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$&#&+ +%#< – G 2P 0A1 LMP – 0371170 EDD – 1070870> PREVIOUS PREGNANCY G1 •
• •
P!+%,#$$ $%&!%#'$ !&+% !& &h "%&h 6,,+%/ ,##+%/ PV. P!&+#%& h! /%# 6 4 ANC 9+$+&$: 2 $!%$: ;# !% +""'%+#. N h+$& 6 #<#$$+9# 9"+&+%/. N h+$& 6 HTN '+%/ #/%!%.
(Rule out H. mole)
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+, GENERAL PHYSICAL EXAMINATION: 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
SYSTEMIC EXAMINATION: CVS – S1 S2 h#!: % "'"'$. RS – NVBS h#!: % !+&+%!, $'%$ h#!. CNS – %## #; – #$#%&. S#%$: "& !% !%+!, %#9#$ – %"!,. PA – N"!, #, $'%$ h#! OBSTETRIC EXAMINATION: INSPECTION: A"#% '%+6", +$&#%#. ,!%;$ %& 6',,. U"+,+'$ – #9#&#. S&+!# /!9+!'": !,+!%$ @ ,+%#! %+/! – #$#%&. N $!$ 9# !"#%: % +,!&# 9#+%$. H#%+!, +6+#$ – %"!,.
• • • • • •
PALPATION: (P!&+#%& #
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L#6& – U%+6" '9# #$+$&!%# $'//#$&+9# 6 $+%#. 1$& P#,9+ G+ – S"&h: '%: h! !,,&!,# "!$$ (%& #%/!/#) $'//#$&+9# 6 h#! 6#,& !& ,# ,#
AUSCULTATION: HS h#! !,%/ &h# ,#6& $+%-'"+,+!, ,+%#: "+ +%&. R!&# – 147"+%: #/',!.
• •
DIAGNOSIS: 20 year old G A 2 with 32 weeks gestation, single li!e fetus with cephalic presentation with head not engaged and not in labour, with mild pre"eclampsia #on treatment$ complicating her pregnancy. FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF 3. CASE OF PREVIOUS LOWER SEGMENT CAESAREAN SECTION N!"# – A%+&! A/# – 23 #!$ A#$$ – A&"!&h+%!/!: #%/#+ O'!&+% – M!+ $#9!%& R#,+/+% – H+%' D!&# 6 !"+$$+% – 0=70>7200> G2P1L1 "#$ +&h = "%&h$ 6 !"#%h#! 6 $!6# %6+%#"#%& HISTORY OF PRESENTING COMPLAINTS:
H'$!%*$ N!"# – V#%;!&#$h A/# – 24 #!$ O'!&+% – P!+%&# I%"# –R$.2007"%& SE S&!&'$ – L# M+,# C,!$$ D!&# 6 #7200>
•
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#&+% !, '# & $&'&# ,!' %%-
•
/#$$+% 6 ,!'. P!&+#%& !$ +%+&+!,, '& % &+!, 6 ,!' !"+%+$&#+%/ +%#&+%$: '& $+%# ,!' !+%$ ##
•
%& !#'!&#: $h# !$ $&# 6 #"#/#% LSCS: !6&# +%6'$+%/ 1 '%+& 6 ,. O'&"# !$ ! ,+9# "!,# 6#&'$: 3.> ;/ !& +&h: !$ +""'%+# !% #<,'$+9#, #!$& 6# 6 1
• •
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#!. M&h# h! % 6#9# '% +$h!/# +% &h# $&- #+. S'&'#$ ## #"9# % &h# >&h ! '& h! & $&! +% &h# h$+&!, 6 1 !$ !$ &h# ! h! !'%+#. L!$& C-$#&+% – 3 #!$ !; (A+, 25&h: 2004)
PRESENT PREGNANCY: T1: T2 !% T3 '%#9#%&6',. EDD-0870870> CONTRACEPTIVE HISTORY: N h+$& 6 '$+%/ !% %&!#&+9# "#&h$.
MENSTRUAL HISTORY: A/# 6 M#%!h# – 12 #!$ P!$& C,#$ – R#/',!: 50->0 ! ,#: 8-= !$ 6,: % !+% !$$!/# 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+, GENERAL PHYSICAL EXAMINATION: 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 ;/
SYSTEMIC EXAMINATION:
CVS – S1 S2 h#!: N "'"'$. RS – NVBS h#!: % !$!, #&$. CNS – NAD. PA – NAD OBSTETRIC EXAMINATION: INSPECTION: D+$&#%# !% 6,!%;$ !# 6',,. U"+,+'$ – %"!,. S&+!# /!9+!'": !,+!%$ @ ,+%#! %+/! – #$#%&. N +,!&# 9#+%$. H#%+!, +6+#$ – %"!,. A 9#&+!, +/h& !!"#+!% +%+$+%: 14 " ,%/ +$ $##% +% &h# +%6!-'"+,+!, #/+%: h#!,#
• • • • • •
+"! +%&#%&+% – % h#&h ;#+,+ 6"!&+%: % $'!-'+ ',/#. PALPATION: (P!&+#%& #
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• • • • • • •
L#6& – U%+6" '9# #$+$&!%# $'//#$&+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& $+%'"+,+!, ,+%#: "+ +%&. R!&# – 1407"+%: #/',!.
• •
DIAGNOSIS: 23 year old G 2 P L with full term single intrauterine pregnancy with pre!ious L%&% with longitudinal lie with cephalic presentation not in labour. FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF . CASE OF R! NEGATIVE PREGNANCY N!"# – S!9+&! A/# – 24 #!$ O'!&+% – H'$# +6# A#$$ – Ch!"!#&
H'$!%*$ N!"# – S!&+$hh!%! A/# – 28 #!$ O'!&+% – C,#; I%"# – R$. 10007#$%7"%&h
SE S&!&'$ – L# M+,# C,!$$ D!&# 6 A"+$$+% – 0>70>70> G2P1L "#$ +&h > "%&h$ 6 !"#%h#! 6 $!6# %6+%#"#%&. HISTORY OF PRESENTING COMPLAINTS
D!&# 6 #70>
•
• • • •
P!&+#%& "#$ +&h > "%&h$ !"#%h#! 6 $!6# %6+%#"#%&. P!&+#%& h! ##% h## 6 #/',! ANC h#;' % 5&h J', !% !$ !9+$# & /#& !"+&&# &#,,+%/ h# &h!& h# , /' #$ %& "!&h +&h &h!& 6 h# ! (&, & h# ! +9!&# !&+&+%#). N h+$& 6 /#%#!,+# #!;%#$$ !% /++%#$$ N h+$& 6 h#!!h#: ,'# 9+$+% ##!$# "+&'+&+% N h+$& 6 ##"! !% '+&+$. N &h# $$&#"+ ",!+%&$.
OBSTETRIC HISTORY: M!+# L+6# – 4 #!$ (%% – %$!%/'+%#'$ "!+!/#) O$&#&+ +%#< – G 2P1L 0A0D1 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!&+#%& #
• • • •
•
L#6& – U%+6" '9# #$+$&!%# $'//#$&+9# 6 $+%#. 1$& P#,9+ G+ – S"&h: '%: h! !,,& !,# "!$$ (%& #%/!/#) $'//#$&+9# 6 H#! 6#,& !& ,# ,#.
AUSCULTATION HS h#! !,%/ &h# ,#6& $+%'"+,+!, ,+%#: "+ +%&. R!&# – 1407"+%: #/',!.
• •
DIAGNOSIS 22 year old G 2 P Lo with ' months amenorrhea, single li!e fetus, not in labour with (h )!e pregnancy. FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF ". CASE OF HEART DISEASE IN PREGNANCY # 1 N!"# – Ch!%!;!,! A/# – 32 #!$ A#$$ – Ch+;!!,,!' O'!&+% – H'$#+6# R#,+/+% – H+%' D!&# !"+$$+% – 1270>7200>
H'$!%*$ N!"# – M!%'%!&h A/# – 35 #!$ O'!&+% – C,&h "#h!%& I%"#–R$.20007"%&h SE S&!&'$ – U# M+,# D!&# 6 #7200>
G3P1L 1A1 "#$ +&h = "%&h$ 6 !"#%h#! 6 $!6# %6+%#"#%& 6 #,+9#. HISTORY OF PRESENTING COMPLAINTS: P!&+#%& "#$ +&h = "%&h$ !"#%h#! 6 $!6# %6+%#"#%& +&h ! h+$& 6 !+! $'/#. N h+$& 6 #!&h,#$$%#$$ % #<#&+%: !,+&!&+%$: h#$& !+%: PND: &h%#!: ##"! 6
• •
6##&. • •
N h+$& 6 !% %/#%+&!, h#!& +$#!$#. N h+$& $'//#$&+9# 6 CC: +%6#&+9# #%!+&+$ +% &h# !$& #$#%& #/%!%.
OBSTETRIC HISTORY: M!+# L+6# – 1 #!$ (%% – %$!%/'+%#'$ "!+!/#) O$&#&+ +%#< – G 3P1L 1A1 LMP – 1571070 EDD – 2270>70> PREVIOUS PREGNANCY: G1 – TND: G9#%"#%& H$+&!,: N 11 #!$: C+# $% !6&# +&h: #+/h# 3 ;/: P$& !&'" #+ %"!,: B;# !% +""'%+#: 3 ANC 9+$+&$: 2TT @ 100 IA ##+9#.
G2 – A&# !& 1 "%&h$ /#$&!&+% (MTP) #!$ !/. PRESENT PREGNANCY: T1 • • • •
H+$& 6 %!'$#! !% 9"+&+%/. N h+$& 6 '+%! $"&"$. N h+$& 6 '/ +%&!;# !+!&+% #<$'#. N h+$& 6 +!.
T2 • • •
?'+;#%+%/ !& 18&h ##;. N h+$& 6 h#!!h# ,'+%/ 6 9+$+% ##"!. P!&+#%& !$ ;# !% +""'%+# – 4 ANC h#;'$: 2 TT @ 100 IA.
T3 • • •
I%#!$# 6#'#% 6 "+&'I&+% – #$#%&. #&!, "9#"#%&$ #$#%&. U%#9#%&6',.
CONTRACEPTIVE HISTORY N h+$& 6 '$+%/ !% %&!#&+9# "#&h$. MENSTRUAL HISTORY A/# 6 M#%!h# – 15 #!$ P!$& C,#$ – R#/',!: 30 ! ,#: 3 !$ 6,: % !+% !$$!/# 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+, GENERAL PHYSICAL EXAMINATION: 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 Pulmonary area Mitral area Tricuspid area
S1S) 'e"r$, no mrmrs.
RS – NVBS h#!: % !$!, #&$. CNS – NAD. PA – NAD OBSTETRIC EXAMINATION: INSPECTION: A"#% +$ +$&#%#: 6,!%;$ !# 6',,. U"+,+'$ – %"!,. S&+!# /!9+!'": !,+!%$ @ ,+%#! %+/! – #$#%&. N +,!&# 9#+%$ $!$ $+%'$#$. H#%+!, +6+#$ – %"!,.
• • • • •
PALPATION: (P!&+#%& #
• • • • •
• • • •
L#6& – U%+6" '9# #$+$&!%# $'//#$&+9# 6 $+%#. 1$& P#,9+ G+ – S"&h: h! !,,&!,# "!$$ #,!&+9#, $"!,, 6#,& $'//#$&+9# 6 h#!. A"+%!, /+&h – 104 ". #+/h& 6 6#&'$ (Jh%$%*$ 6"',!) – 2800 /". A/# 6 6#&'$ (M D%!,*$ 6"',!) – 40 ##;$.
AUSCULTATION: HS h#! !,%/ &h# ,#6& $+%'"+,+!, ,+%#: "+ +%&. R!&# – 1407"+%: #/',!.
• •
DIAGNOSIS 32 year old G 3P L A with full term pregnancy with cephalic presentation, not in labour with a pre!ious history of cardiac surgery. FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF $. CASE OF HEART DISEASE IN PREGNANCY # 2 N!"# – !+! T!
H'$!%*$ N!"# – R#h"!%
A/# – 25 #!$
A/# – 30 #!$
A#$$ – Ch+;!!,,!'
O'!&+% – P,!$&+ I&#"$ $#,,#
O'!&+% – ;# +% A/!!&&+ 6!&
I%"#–R$.30007"%&h
R#,+/+% – H+%'
SE S&!&'$ – U# M+,# C,!$$
D!&# 6 !"+$$+% – 087117200>
D!&# 6 #
P+"+/!9+! "#$ +&h = "%&h$ 6 !"#%h#! PRESENTING COMPLAINTS P!+% !"#% S#,,+%/ 6 &h ,# ,+"$ Ch#$& !+% !% #!&h,#$$%#$$
• • •
HISTORY OF PRESENTING COMPLAINTS:
– 13 !$. – 13 !$. – 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+'$,.
CONTRACEPTIVE HISTORY N h+$& 6 '$+%/ !% %&!#&+9# "#&h$. MENSTRUAL HISTORY:
A/# 6 M#%!h# – 15 #!$ P!$& C,#$ – R#/',!: 30 ! ,#: 3 !$ 6,: % !+% !$$!/# 6 ,&$. LMP – 0370370> FAMILY HISTORY N h+$& 6 DM: HTN. N h+$& 6 !% %/#%+&!, h#!& +$#!$# !"%/ #,!&+9#$. PAST HISTORTY N h+$& 6 6,##&+%/ +%& !+%$ 6#9# +% &h# h+,h !% !&+#%& %& % #%+'# h,!<+$. N h+$& $'//#$&+9# 6 !% &h# %/#%+&!, h#!& +$#!$#. N h+$& 6 h#!& $'/#. N h+$& $'//#$&+9# 6 DM HTN. N h+$& 6 TB: #+,#$ !$&h"!. N h+$& 6 #9+'$ h$+&!,+!&+% &#!&"#%& 6 h#!& ! +,"#%&$.
• • • • • •
PERSONAL HISTORY D+#& – M+<# A#&+&# – G S,## – S'% B#, @ B,!# – R#/',! H!+&$ – N+, GENERAL PHYSICAL EXAMINATION: M&h# +$ ! '%/ ,!: "#!&#, '+,& !% %'+$h#: %$+'$: !,#& @ #!&+9# #,, +#%&# & &+"#: ,!# !% #$%. P',$#
– ==7"+%: #/',!: / 9,'"#: %"!, h!!&#: !,, PP 6#,&. JVP– !+$# ( ").
BP
– 127=0 "" 6 H/ +% ,#6& '# ,+" +% $'+%# $+&+%.
RR
– 187"+%: #/',!: TA
T#"#!&'#
– P!&+#%& +$ !6#+,#
P!,,
– A$#%&
I&#'$
– A$#%&
C!%$+$
– A$#%&
C,'+%/
– A$#%&
E#"!
– A$#%&
L"h!#%!&h – A$#%& Th+
– N"!,
B#!$&$
– N"!,
S+%#
– N"!,
G!+&
– N"!,
H#+/h&
– 10 "
#+/h&
– 0 ;/
SYSTEMIC EXAMINATION: CARDIO-VASCULAR SYSTEM: INSPECTION N #+!, ',/#. A+!, +"',$# – ,#6& 4&h +%&#-$&!, $!#: 2 " ,!&#!, & M+-!9+',! ,+%#. N &h# !%"!, ',$!&+%$. N +,!&# 9#+%$ 9# &h# h#$& !,,: % $!$.
• • • •
PALPATION I%$#& 6+%+%/$ ## %6+"#. A#< #!& – ,#6& 4&h +%&#-$&!, $!#: 2 " ,!&#!, & M+-!9+',! ,+%#. P!!$&#%!, h#!9# – #$#%&. N &h+,, 6#,&. N !%"!, ',$!&+%$.
• • • • •
AUSCULTATION CVS
Aort!4 "re"
S1 #o$, S) 'e"r$ , No mrmrs
P#mon"r "re"
ESM 3 resent
M!tr"# "re"
MDM 3 resent
Tr!4s!$ "re"
S1S) 'e"r$, No mrmrs
RS – NVBS h#!: % !$!, #&$. CNS – NAD. PA – NAD OBSTETRIC EXAMINATION: INSPECTION: A"#% +$ +$&#%#: 6,!%;$ !# 6',,. U"+,+'$ – %"!,. S&+!# /!9+!'": !,+!%$ @ ,+%#! %+/! – #$#%&. N +,!&# 9#+%$ $!$ $+%'$#$. H#%+!, +6+#$ – %"!,.
• • • • •
PALPATION: A"+%!, +'"6##%# – > " S"h$+-6'%!, h#+/h& – 28 " (#$%$ & 32 ##;$) UNDAL GRIP – S6&: ! @ %%-!,,&!,#: $'//#$&+9# 6 B##h L!&#!, G+ – % ,+;# $&'&'#$ % &h# +/h& $+# $'//#$&+9# 6 ,+" '$
• • • •
• • •
U%+6" #$+$&!%# % &h# ,#6& $+# $'//#$&+9# 6 $+%# 1ST PELVIC GRIP – S"&h: h!: !,,&!,# "!$$ $'//#$&+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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