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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
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