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Case Presentation

Dr. Umme Shamma


Intern Doctor of GU-III
SOMCH
A 26 years lady, 2nd gravida, 39+ weeks of
pregnancy admitted with painless per vaginal
bleeding
Particulars of the patient:
Name : Alen Begum
Age : 26 year
Husband’s Name : Munna Mia
Occupation : Business
Religion : Muslim
Address : Osmaninogar, Sylhet
Date of Admission : 04.02.19 at 5.30pm
Date of examination : 04.02.19 at 5.40pm
Chief Complaints
1. Amenorrhoea for 39 weeks.
2. Painless per vaginal bleeding for 1 day.
History of present illness
According to statement of patient she was
Amenorroheic for 39 weeks.Before that She
was regularly menstruating women.Her
pregnancy was dated by early USG. She was
not on regular ANC. Up to nine months her
pregnancy was uneventful. Suddenly she
noticed painless per vaginal bleeding which
was initially scanty in amount
Contd.
for 1 day later on excessive in amount for last
3 hours before admission. There was no
history of trauma or fall. Her fetal movement
was good. She admitted in SOMCH on 4.2.19
for further management.
Obstetrical History
Married for : 4 years.
Gravida : 2nd
Para : 1 (Vaginal delivery)
Age of last confinement : 2 years.
Abortion : Nil
Obstetrical Chart
SL Years of Duration Complication ANC Place of Mode of Complication Paeperium
of delivery
No pg of pg during pg delivery delivery
1 2017 9 month Uneventful 2 times Home NVD Absent Uneventful
Menstrual History
• Age at menarche : 13 year
• Menstrual cycle : 28-30 days
• Menstrual period : 4-5 days
• Menstrual flow : Average
• Dysmenorrhoea : Absent
• LMP : 3rd May, 2018
• EDD : 10 February, 2019
• Contraceptive History : This couple didn’t practice
any contraceptive method.
History of past illness:
Patient was normotensive and non-diabetic.
Socio-economic History :
She came from middle class family
Drug History :
No significant drug history.
Personal history:
Betal nut chewer.
Family History
Nothing contributory
Immunization history:
She was properly immunized against tetanus.
General Examination
• Appearance : ill-looking
• Body built : Average
• Anemia : Mildly Anemic
• jaundice :Absent
• Temperature : Normal
• Odema : Present
• Dehydration : Absent
• Pulse : 90 b/min
• BP : 120/80 mmHgP
• Lungs : Clear
• Heart : 1st & 2nd heart sound is audible in all four areas.
• Breast : Normal pregnancy changes.
• Thyroid gland : Not palpable
• Lymph node : Not palpable
Per abdominal examination
Inspection :
Abdomen was uniformly enlarged, pyriform in shape,
Linea niagra & striae gravidarum was present, umbilicus
centrally placed & everted.

Palpation :
Uterus– 36 weeks in size
Fundal grip – soft, broad and irregular part felt suggestive
of breech.
Lateral grip : Smooth, curved part felt- suggestive of back
(left side), knob like irregular part suggestive of limbs
(right side)
Contd.
1st Pelvic grip : Hard, Smooth, round and ballotable denotes head
2nd Pelvic grip:Head not Engaged

Fetal movement – Present


Abdominal girth was about 95 cm.

Auscultation :
FHR – 140 b/min at left
spinoumbillical line which was regular.
P/V/E
P/S/E : Active per vaginal bleeding was present
which was bright red in colour.
Salient feature
Mrs. Alen Begum, 26 years, para-1, 2nd gradiva hailing
from Osmaninagar , Sylhet admitted in SOMCH with
complaints of amenorrhoea for 39weeks Before that
she was regularly menstruating women.Her pregnancy
was dated by early USG . Upto 9 months her pregnancy
was uneventful.suddenly she noticed painless per
vaginal bleeding for 1 day which was bright red in
colour initially scanty in amount then excessive for last
3 hours. She was properly immunized against
tetanus.she has no history of trauma or fall.
Cond.
• On general examination I found patient was
mildly aneamic, pulse – 90 b/min, BP – 120/80
mmHg, T- 98oF, edema (+) . Breast
examination showed normal pregnancy
changes, Thyroid gland was not palpable, Her
cardio-respiratory system reveal nothing
abnormality.
Contd.
• On P/A/E- Abdomen was uniformly enlarged ,
pyriform in shape, linea nigra & striae gravidarum
was present. Her uterus was about a 36th weeks
of size. Abdominal girth was 95 cm. There was a
singleton pregnancy, cephalic presentation and
longitudinal lie. Head was not engaged. FHR was
about 140 b/min at left spino-umbillical line
which was regular. P/S/E- Active per vaginal was
present which was bright red in colour. She had
no H/o trauma or fall.
• So my clinical diagnosis is a
nd
case of 2 gravida with 39
weeks of pregnancy with APH.
Investigation
• Hb%
• Blood grouping & Rh typing.
• RBS
• Urine R/E
• VDRL
• HBsAg
• HIV
• USG of pregnancy profile.
Management
• We were counseling patient and her attendance regarding her
management and pregnancy outcome.
• Complete Bed Rest
• Wide Bore I/V cannula
• Intravenous fluid is to be started
• Blood transfusion after grouping and cross-matching
• Iron and folic acid
• Catheterization to monitor urine output

Advice her attendance for arrangement of blood at least 2 unit. We took


consent from patient and her attendance. With due consent she was
under gone LSCS on 4.2.19 at 7:00pm, and an alive male baby came
out.
• Her early post operative days
and puerperium was
uneventful. There was no
history of PPH.
Thank You

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