CC :-

Mdm S, a 28 y/o Malay lady with NKMI, Para1+1, post SVD 5 hours ago which she was at 39
WOG, was brought to PAC Hosp Selayang for labour.

HOPI :-

- Previously well throughout pregnancy until 2 am this morning, currently at 39 WOG

when suddenly developed abdominal pain every 5 minutes with increasing intensity
and not reducing with analgesic.
- Also passed mucus with blood streak per vaginally, however no gushing of fluid per
vaginally.
- Immediately brought by husband to PAC Hosp Selayang and CTG was done showing
normal fetal acitivity. VE was done with cervical opening of 3 cm. She was admitted
in labour room and ARM was done and CTG monitoring was continued.
- She delivered a baby girl via SVD at 10 am after she had fully os. The baby cried
immediately after birth with no NICU admission. The birth weight was 3.4 kg.
- Peripartum was uneventful, no excessive bleeding.
- She had 1 tear and already sutured. No episiotomy done.
- In ward, the patient has not ambulated yet and the baby has not passed stool or
urine yet. Breastfeeding was normal.
- She passed lochia which is red in colour with no foul-smelling PV discharge. She had
to use 3 maxi pads, not fully soaked.
- The patient unsure whether the baby had received Hep B injection or not.
- Otherwise, baby and mother are well.

AN history :-

- This is a planned & wanted pregnancy.

- Initially missed period for 2 months, did self UPT & result +ve, so went to KK JB, USS
was done and the pregnancy was confirmed at 7 WOG
- Her LMP was 25/9 (sure of date, x h/o contraceptive used, no h/o breastfeeding and
had regular period), so her EDD was given at 2/7/17 based on the LMP.
 - She did booking on the same day : normotensive throughout pregnancy, no
glycosuria, no proteinuria, Hb level 13 g/dL (no anemia throughout pregnancy),
blood group is O+, did infective screening and results were negative, here pre-
pregnancy weight was 41 kg.
- Had mild morning sickness up till 12 WOG, no hosp admission.
- AN f/up at private clinic with total of 7 scans done in this current pregnancy showing
singleton fetus with normal growth velocity, adequate liquor and normal placenta
location.
- She took supplement such as vitamins and folate.
- MGTT was done once at 28 WOG indicated for rapid weight gain of 15 kg in this
pregnancy, past bad obs history and age >25 y/o. The result was 4.3 mmol/L
(normal)
- She felt quickening at 20 WOG (normal fetal kicks, usually start counting at 9 am and
finished 10 kicks at 2-3 pm)
- Had ATT injection twice.
- Otherwise, no fever, no UTI sx, no hosp admission, no APH, and no other complaints
throughout this pregnancy (no hypo/hyperthyroid symptoms throughout pregnancy)

Past obs history :-

- This is 1st marriage

- Para 1 +1
- Had spontaneous complete miscarriage 2 years ago at 20 WOG. It was confirmed by
a scan and no D&C done.
- During the last pregnancy 2 years ago, patient was diagnosed with thyroid in
pregnancy.
- Initially, patient had symptoms of palpitations with chest pain, fatigue, heat-
intolerance, LOA, LOW (5 kg during the pregnancy), fever and easily irritated with
increased sweating during early pregnancy for 1 month period. However, there were
no altered in bowel habit, no sob, and no legs swelling.
- She did not seek early medical tx until she developed severe nausea & vomiting
(more than 10 times, unable to tolerate orally and a/w fatigue) at 8 WOG. She was
admitted in JB Hosp for 1 week plus and during admission TFT was done & she was
 diagnosed with thyroid disease in pregnancy. She was started on daily PTU which she
took up to 3 months duration.
- 2 days after discharged, she developed sudden onset of blackout and she was
admitted in ICU for 2 weeks. She was discharged well after 2 weeks, with normal
fetal activity.
- However, starting from 12 WOG the fetal started showing poor growth based on
USS.
- She had a complete miscarriage at 20 WOG and after miscarriage, TFT was repeated
and the result normalized and she completely recovered from the thyroid disease.
- Otherwise, pt did not have any thyroid disease prior to the pregnancy, and she did
not have any other medical illness during the pregnancy (such as GDM/PIH). The
patient remained well after that.

Past gynae hx :

- Menarche : 13 y/o
- Regular cycle of 5 days flow in 28 days of cycle (peak flow on 2nd day)
- Use 2 pads/day (not fully soaked)
- No menorrhagia
- Had dysmenorrhea, but not requiring any analgesic
- No history of gynae problem/surgery
- Never had any pap smear done
- BSE done sometimes for health awareness

PMHx :-

- Aside from hospitalisation during pregnancy, had one hospitalisation before for
surgical removal of skin swelling over the abdomen. Uneventful.
- No U/L chronic illness (no DM, no HTN, no asthma, no thyroid dz)
- No allergy to food or meds
- Never took any supplement/traditional medications

FMHx :-
 - Dad has ESRF on dialysis, mom healthy
- 1st out of 4 siblings. All healthy
- No family member with same history as hers
- No malignancy running in family

Social hx :-

- Lives in Btg Kali in a double storey terrace with husband (good basic amenities)
- Shes a housewife
- Husband is a police (RM1,200/month)
- Husband is a smoker
- Pt is a non smoker, no alcohol, no illicit drug.

p/e : normal.