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PRESENTATION
OB PGI
OBJECTIVES
U/A
HbSAg
Blood typing,
FBS, 75 g OGTT,
Papsmear
PRENATAL HISTORY
PELVIC UTZ (11/17/16 )
Pregnancy Uterine, at 28 weeks 6 days (+/- 2 weeks)
100-g
glucose
FASTING 5.2 mmol/L Within normal
1 HR 9.2 mmol/L Within normal
2 HR 9.4 mmol/L Slightly increased
3 HR 8.8 mmol/L Slightly increased
PRENATAL HISTORY
URINALYSIS
- gross: Light yellow, hazy
- ph: 6
- specific gravity: 1.010
-Protein: NEGATIVE
-Glucose: NEGATIVE
-Microscopic
-RBC: 0-1 /HPF
-WBC: 0-2/HPF
-Epith.: moderate
-Bacteria: few
PRENATAL HISTORY
CBC
-WBC: 13.83x 10 ^9/L
-HGB: 124 g/L
-HTC: 0.36 L/L
-RBC: 4.12
-PLT: 254 x 10 ^9/L
-Neutrophils: 84.70
-Lymphocytes: 11.90
-Monocytes: 3.20
-Eosinophils : 0.10
-Basophils: 0.10
PRENATAL HISTORY
HbSag- Nonreactive
Bloodtype- “A” (+)
PRENATAL HISTORY
Medications
Folic acid tab OD PO,
Ferrous sulfate tab OD PO
Diet:
2 glasses of milk per day
1 banana per meal
Inspection:
normocephalic, no lumps lesions,
or deformities
Palpation:
Ocular motility:
full range of extraocular movements
Tonometry:
soft
Fundoscopy:
(+) red orange reflex, clear media, distinct disc
border, cup-disc ratio of 0.3, AV ratio of 2:3, (-)
hemorrhage/exudates, (+) foveal reflex
EARS
Inspection:
symmetrical; no deformities; no lesions, no discharges,
no swelling or redness
Palpation:
no masses or lumps, no tenderness on mastoid area, no
pain when ear is tugged
Otoscopy:
no discharges, few cerumens seen, tympanic membrane
is pearly white and intact; not retracted or bulged
Auditory exam:
patient can hear whispered words
NOSE
Inspection:
symmetrical, no deformities, no lesions, nasal
mucosa is pinkish. Nasal septum is midline and
not perforated; no swelling or redness
Palpation:
No tenderness, no masses or lumps
Sinuses:
maxillary and frontal sinuses are not tender; (+)
red glow upon transillumination
MOUTH AND THROAT
Inspection:
Lips: no deformities, pink, no lesions, dry
Uvula: midline
Inspection:
trachea is midline; no lesions, no scars
Palpation:
Inspection:
no lesions, no inflammation, no
dimpling, no abnormal nipple
discharges, no deformities
Palpation:
Percussion:
resonant sounds on lung fields
Auscultation:
no adventitious breath sounds
CARDIOVASCULAR SYSTEM
Inspection:
no gross chest deformities; no visible pulsations
Palpation:
maximum point of impulse on 5th intercostals space 5-7cm
lateral to midsternal line with small amplitude
Percussion:
not performed
Auscultation:
apex beat heard in 5th intercostals space 5-7 lateral to the
midsternal line; good S1 and S2; no abnormal heart sounds
heard such as murmurs or clicks
ABDOMEN
Inspection:
gravid, round and protuberant, no swelling,
no observable masses, (+) linea nigra; (+)
striae gravidarum
No organomegaly noted
FH: 20cm
Distended abdomen,
size of 29 weeks gravid
FH = 20cm
Linea nigra
striae
ABDOMEN
Abdomen
Palpation: Leopold’s Maneuver
L1 – breech
L2 – fetal back at maternal left side; fetal
extremities at maternal right side
L3 – cephalic
L4 – floating
FHT – 140 bpm
PELVIC EXAM
EXTERNAL GENITALIA: grossly female, non
edematous
VAGINA: no masses, no lesions
UTERUS: gravid
CERVIX:
Dilatation:2cm
Effacement: slightly effaced
Position: midposition
PELVIC EXAM
PRESENTATION:
Membranes: intact
Station: -3
Fluid: clear
Adequate pelvimetry
EXTREMITIES
Inspection:
no gross deformities; symmetrical; parallel
to each other; no swelling, no redness, no
inflammation or lesions; not cyanotic; no
edema
Palpation:
Range of motion:
full
NEUROLOGIC EXAM
Mental status exam:
awake, alert, responsive, oriented to time,
place, and person; appropriate affect; no
abnormal movements; immediate and
remote memory intact, fluent speech; (-)
aphasia
NEUROLOGIC EXAM
Cranial nerves:
1: able to smell perfume
2, 3: (+) near response test; (+) consensual and direct papillary reflex
Cerebellar signs:
(-) ataxia, (-) dysmetria, (-) dysdiadochokinisia
Meningeal Signs:
(-) babinski’s and (-) kernig’s sign
LOGICAL IMPRESSION
GESTATIONAL DIABETES
POINTS TO SUPPORT:
FBS= 128MG/dL
100g OGTT
2-hr = 9.4 mmol/L
3-hr = 8.8 mmol/L
S–O–A–P
Day 0 (11/17/16)
S - Patient was seen and examined.
- Patient complained of hypogastric pain radiating to the
flank area with a pain scale of 6/10 associated with irregular
uterine contractions with 3-4min interval lasting for 40-50secs.
S–O–A–P
Day 0 (11/17/16)
O Inspection:
gravid, round and protuberant, no swelling,
no observable masses, (+) linea nigra; (+)
striae gravidarum
No organomegaly noted
FH: 20cm
COURSE IN THE ER
S–O–A–P
Day 0 (11/17/16)
O Abdomen
Palpation: Leopold’s Maneuver
L1 – breech
L2 – fetal back at maternal left side; fetal
extremities at maternal right side
L3 – cephalic
L4 – floating
FHT – 140 bpm
COURSE IN THE ER
S–O–A–P
Day 0 (11/17/16)
O CERVIX:
Dilatation: 2cm
Effacement: slightly effaced
Position: midposition
PRESENTATION:
Membranes: intact
Station: -3
Fluid: clear
COURSE IN THE ER
S–O–A–P
Day 0 (11/17/16)
P Medication:
Dexamethasone 6mg IM now then every
12 h x 1 more dose
Nifedipine 30mg tab now then 10mg tab
every 20min until uterine contractions
percieved or up to 160mg/day
COURSE IN THE ER
S–O–A–P
Day 0 (11/17/16)
P Attach to CTG
Monitor fetal heart rate pattern
Follow up laboratory results:
FBS
Hba1c
CBC
COURSE
IN THE
LABOR ROOM
COURSE IN THE LABOR ROOM
S–O–A–P
Day 1 (11/18/16)
S - Patient was seen and examined.
- Patient still complained of hypogastric pain radiating to the
flank area with a pain scale of 8/10 associated with irregular
uterine contractions with 2-3min interval lasting for 40-50secs.
S–O–A–P
Day 1 (11/18/16)
O - Vital Signs
BP: 90/60 mmHg, left arm, supine
HR: 98 beats per minute, tachycardic
RR: 20 cycles per minute, tachypneic
Temp: 37.0 °C
O2 sat: 99%
-FHT = 140-150 bpm
-CTG: FHR category 1
-FHR pattern: 140-150bpm
-Variability: moderate
-Accelerations: present
COURSE IN THE LABOR ROOM
S–O–A–P
Day 1 (11/18/16)
O Inspection:
gravid, round and protuberant, no swelling,
no observable masses, (+) linea nigra; (+)
striae gravidarum
No organomegaly noted
FH: 20cm
COURSE IN THE LABOR ROOM
S–O–A–P
Day 1 (11/18/16)
O Abdomen
Palpation: Leopold’s Maneuver
L1 – breech
L2 – fetal back at maternal left side; fetal
extremities at maternal right side
L3 – cephalic
L4 – floating
FHT – 140 bpm
COURSE IN THE LABOR ROOM
S–O–A–P
Day 1 (11/18/16)
O CERVIX:
Dilatation: 8-9cm
Effacement: 70-80% effaced
Position: midposition
PRESENTATION:
Membranes: ruptured
Station: -3
Fluid: clear
COURSE IN THE LABOR ROOM
CBC RESULT
WBC 13.83 INCREASED
HGB 124 WITHIN NORMAL
HCT 0.36 WITHIN NORMAL
MCV 87.6
MCH 30.10
RBC 4.12 WITHIN NORMAL
PLATELET 254 WITHIN NORMAL
NEUTROPHIL 84.7 INCREASED
LYMPHOCYTE 11.9 DECREASED
MONOCYTE 3.20 WITHIN NORMAL
COURSE IN THE LABOR ROOM
URINALYSIS RESULT
COLOR YELLOW
TRANSPARENCY HAZY
PH 6
SPEC GRAV 1.010
PROTEIN NEGATIVE
GLUCOSE NEGATIVE
EPITHELIAL MODERATE
BACTERIA FEW
RBC 0-1
WBC 0-1
COURSE IN THE LABOR ROOM
S–O–A–P
Day 1 (11/18/16)
P Termination of Pregnancy
Attach to CTG
Monitor fetal heart rate pattern
COURSE IN THE LABOR ROOM
S–O–A–P
Day 1 (11/18/16)
G2 P1 (0111) Pregnancy Uterine delivered
cephalic preterm livebirth via Normal
Spontaneous Delivery; Gestational Diabetes
Mellitus
COURSE IN THE LABOR ROOM
S–O–A–P
Day 1 (11/18/16)
BABY DATA:
Sex: Male
Weight: 1390g
Length: 38cm
APGAR Score: 8,9
BS: ???
CASE DISCUSSION