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1. 24-HOUR STATISTICS OF DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY 2081/06/19 9:00am to 2081/06/20 9:00 am 3 rd on call : Assoc. Prof . Dr. Jyotshna Sharma 2 ND on call : Assoc. Prof. Dr. Jyotshna Sharma 1 st on call : Dr Durga /Dr . Barsha /Dr. Kristina /Dr . Ranjita /Dr . Tanuja / Dr.Rupika

2. 2081/06/20 2081/06/21 3 rd on call Assoc. Prof Dr. Dipty Shrestha Assoc. Prof. Dr. Jyotshna Sharma 2 nd on call Dr. Usha Khanal Dr. 1 st on call Duwakot Camp Duty Dr. Taanya / Dr. Mamta Dr. Pragya / Dr Dikshya Dr. Pratigya / Dr. Sophiya Dr Rupika Dr. Barsha / Dr. Priety Dr. Rubina / Dr. Ranjita Dr. Durga / Dr. Tanuja Dr.Pratigya Clinical teaching 5 th sem Clinical teaching 8 th sem Tutorial 8 Th Sem Lecture 8 th sem (2-3pm) Lecture 6 th sem (12-1pm) PG Academic Class

3. Total cases yesterday: 30 Discharge: 7 Remaining: 23 New admission: 9 Total cases today: 32

4. ICU: 1 Highcare : 1 Blood transfusion : x Post operative : x Referred in: x Referred out: x Refused service : x Consultation requested : x Consultation attended : x Expulsion : x Special cases in the ward : x Cases in PNC with additional risk : x Still birth : x Sick Babies : x NND: x

5. TOTAL DELIVERY - 3 Total delivery 3 Normal delivery 2 Vaginal delivery X Emergency LSCS 1 Elective LSCS X

6. NEW ADMISSION : 9 UNIT OBS GYNAE Total I X X X II 9 X 9 Total 9 X 9

7. Total cases : 32 UNIT OBS GYNAE Total I 4 1 5 II 25 X 25 Dr. UK 2 X 2 Total 31 1 32

8. SICU CASE FOR UNIT II 1) Mrs Monika Joshi 37 yrs P2L1A1 on 1 st day following Emergency LSCS for Fetal Distress (Fetal Bradycardia) with IUGR with doppler changes with Chronic HTN superimposed with severe preeclampsia with low lying placenta and transverse lie and previous LSCS and history of Early NND She was admitted on 4days back as G3P1L0A1 at 28 weeks 4 days of gestation with Chronic HTN superimposed with severe preeclampsia with low lying placenta with transverse lie with previous LSCS and history of Early NND At 4pm yesterday Her BP was 210/120mmhg, Inj Labetalol 30mg IV was given and after Inj Labetalol her BP was constatnt 200/110mmhg so she was shifted to SICU 24 Hours Update: 2 episode of hypoglycemia today at 1 am(53mg/dl), and 3 am(37mg/dl) BP-154-210/104/130mmhg, PR-80-86bpm, RR-20-24bpm, Temp I/O: 2745/1460 +1285ml 8

9. OT FINDINGS: Adhesion present between posterior wall of uterus and retro peritoneum LUS: not formed Liquor: clear, scanty Presentation: Transverse RSA Placenta: Anterior low lying B/L tubes and ovaries: Normal EBL: 300ml Urine: 300ml, clear I/O: 2745/1460 +1285ml 10/6/2024 9

10. INVESTIGATIONS 2081/6/17 2081/6/20 CBC:TC N/L 10500 75/20 13500 72/25 HB 13.8 12.3 PLATELETS 152000 153000 RBS 111 NA/K UREA/CREAT 135/3.9 35/1.0 135/3.9 33/0.7 URIC ACID LDH 8.1 334 LFT:BT/BD SGPT/SGOT ALP 0.6/0.2 22/36 162 0.6/0.2 28/42 83 24 HOUR PROTEIN EXCRETION 7290 URINE RE: PC ALBUMIN 6-8 ++ 1-2 ++ 10/6/2024 10

11. MEDICATIONS: INJ. LABETALOL @40ml/ hr TAB AMLODIPINE/LOSARTAN 1 TAB PO BD INJ TRAMADOL 50MG IV TDS INJ ONDEM 4MG IV TDS 10/6/2024 11

12. HIGH CARE CASE UPDATE (UNIT II) Bina Magar 27yrs P1L1A2 with septic abortion 24 hours update: She is afebrile for more than 24 hours She received Tab. Misoprostol 600mcg S/L After which she had no pv bleeding Vitals : BP- 100-114/60-88mmhg, PR-56-78bpm, RR-14-32bpm, Temp-98-98.6 F , SP02-93-96% USG (A+P): Uterus normal size. Heterogeneous content about 14.4ml with internal vascularity noted in fundal region. Minimal fluid in endometrial cavity. Likely RPOC 10/6/2024 12

13. INVESTIGATIONS 2081/6/19 CBC:TC N/L 9400 70/26 HB 9.1 PLATELETS 155000 NA/K UREA/CREAT 141/3.5 15/0.5 LFT:BT/BD SGPT/SGOT ALP 1.5/0.7 24/36 121 DENGUE IGG, IGM NS1 NEGATIVE SCRUB TYPHUS IGG/IGM NEGATIVE 13

14. MEDICATIONS: 1)INJ NORADRENALINE 0.2ML/HR 2)INJ DURATZ 4.5GM IV TDS ( 3DOSES) 3)INJ DOXYCYCLINE 100MG IV BD ( 4 DOSES) 4)INJ AZITHRO 500MG IV OD(2 DOSE) 5)INJ PARACETAMOL 500MG IV TDS 10/6/2024 14

15. NEW ADMISSION FOR UNIT II 1 ) Sajina Tamang 2 7 yrs. P2L2A1 on day following Normal delivery with 2nd degree perineal tear She was admitted yesterday as G3P1L1A1 at 38 weeks and 5 days of gestation in Latent Phase of Labor Labour progressed and she delivered SLTM at 1:56AM weighing 2.99kg with APGAR 7/10, 9/10 Post delivery vitals are stable Baby is with mother 15

16. 2 ) Rashmi Dhamala 25 yrs (EHS CASE OF DR. MEENA THAPA MA’AM) Primigravida at 3 8 weeks and 6 day s of gestation with GDM, vasculitis and history of APLA positive status with history of primary subfertility Admitted for Elective LSCS today C/O: Amenorrhea for 9 months , perceivng adequate fetal movement s . O/E:G.C: Fair. PIE : N i l P/A: Uterus : ~ Term Size, Longitudinal lie, cephalic. FHS+ regular (136 bpm) INV (06/13): Hb:11.7, TC:11300 N75L20 Platelets:1 ,83 ,000 , Ur/Cr:20 /0.7, Na/K: 136/4.6, PT/INR: 15/1.1, BT/BD: 0.4/0.1, SGPT/SGOT: 41/46, ALP:137 Urine RME : PC:1-3 EC:3-5 Last scan(06/13): SLIUP at 36 weeks and 3 days of gestation, cephalic, plt : posterior UUS, AFI: 19.67 cm, EFW: 2.8kg, BPD: 89.86mm Plan: Elective LSCS today 10/6/2024 16

17. 3 ) Pema Sherpa 40 yrs G3P1L1A1 at 3 8 weeks and 3 day s of gestation with GDM (under diet control) with previous LSCS Admitted for ERCS with BTL today C/O: Amenorrhea for 9 months , perceivng adequate fetal movement s . O/E:G.C: Fair. PIE : N i l , Vitals: Stable P/A: Uterus : ~ Term Size, Longitudinal lie, cephalic. FHS+ regular (136 bpm) INV (06/19): Hb:13.7, TC:7600 N61L34 Platelets:1 ,51 ,000 , Ur/Cr:16 /0.5, Na/K: 136/3.8, PT/INR: 16/1.1,Urine RME : PC: 2-4 EC: 6-8 Last scan(06/13): SLIUP at 35 weeks and 5 days of gestation, cephalic, plt : posterior UUS, AFI: 13.7 cm, EFW: 2.6kg, BPD: 91.66mm Plan : ERCS with BTL today 10/6/2024 17

18. 4) Anita kumari karki 28 yrs G2P1L1 at 36 weeks and 1 day of gestation with Prev. CS with AGE with GDM. C/O: Amenorrhea for 8 and half months, passage of loose stool for 2 days, 7-8 episodes per day, pain abdomen over periumbilical region for 3 days and perceiving adequate fetal movements O/E: GC: Fair, PIE: Nil, Vitals: stable P/A : uterus 34 weeks size, cephalic, longitudinal, FHS: + 140bpm P/V: Soft, central, uneffaced, OS Closed HS (-3) Last Scan (06/11): SLIUP at 33+ 4 WOG, cephalic, plt : fundic posterior, AFI: 13.75cm , EFW: 2.2kg Plan: close feto maternal monitoring 10/6/2024 18

19. 5 ) Laxmi Sapkota 31yrs (NEW ADMISSION) P2L2A1 on day following Normal delivery with history of complete perineal tear with GDM under diet control She was admitted yesterday as G3P1L1A1 at 39 weeks and 6 days of gestation in for induction of Labor She received Tab. Mifepristone 200mg PO single dose Labor progressed and she delivered SLTM at 4:38AM weighing 3.2kg with APGAR 7/10, 9/10 Post delivery vitals are stable 19

20. LABOR ROOM UPDATE 1 ) Sangita Thapa 22yrs. (NEW ADMISSION) G2A1 at 38 weeks and 3 days of gestation with PROM in LPOL C/O : amenorrhea for 9 months, PV leaking for 10hours and perceiving adequate fetal movements O/E: GC: Fair, PIE: Nil, Vitals: stable P/A : uterus term size , cephalic, longitudinal, FHS: + 148bpm P/S: cervix healthy, frank leaking, HVS taken, liquor clear (6am)P/V : Soft, posterior, uneffaced, OS-closed, HS (-3), liqor -clear INV (06/19): TC: 9100 , N:70,L:25, Hb : 13.7 Plt : 179000 , RBS: 111 RFT: Ur/Cr: 16/0.6, Na/K: 135/4.1 PT/INR: 14/1.0 Last Scan ( 06/09 ): SLIUP at 35+1 WOG, cephalic, plt : posterior UUS, AFI: 13.3cm , EFW: 2.5kg She is under Inj Oxytocin 2.5units in titrating doses PLAN-Watch for progress of labor 10/6/2024 20

21. 2 ) Kabita Maharjan 31 yrs. Primigravida at 34 weeks and 6 days of gestation in LPOL with B orderline oligohydramnios C/O: amenorrhea for 8 months, PV bleeding +, 1 pad partially soaked and perceiving adequate fetal movements O/E: GC: Fair, PIE: Nil, Vitals: stable P/A : uterus 34 weeks size, cephalic, longitudinal, FHS: + 148bpm, contraction + P/S: cervix smeared with blood (6am)P/V: Soft, central, 50%effaced, OS-1.5cm,HS (-2), membrane(+) INV(06/19): TC: 9000, N81 L15, Hb : 13.1, PLT: 157000 (06/16): RBS: 70, UR/CR: 22/0.5, Na/K: 137/3.7, BT/BD: 0.6/0.2, SGPT/SGOT: 15/22, ALP: 79, LDH: 198, PT/INR: 14/1.0 PC:2-3, EC: 1-3, HVS C/S: NG Last Scan (06/16): SLIUP at 33 WOG, cephalic, plt : anterior UUS, AFI: 8 cm , EFW: 2.0kg , BPD: 81.8mm, normal doppler study of fetal umbilical artery and MCA Plan: close F eto maternal monitoring and watch for progress of labor 21

22. 3 ) Ankita Adhikari Khatri 26 yrs. (NEW ADMISSION) G2A1 at 32 weeks and 5 days of gestation with PROM C/O: amenorrhea for 7 months, PV leaking for 14 hrs and perceiving adequate fetal movements O/E: GC: Fair, PIE: Nil, Vitals: stable P/A : uterus 34 weeks size, cephalic, longitudinal, FHS: + 148bpm, Contractions(25s,25s) P/S: cervix healthy, frank leaking, HVS taken, liquor clear (AT 7:45am)P/V: Soft, central, 30%effaced, OS 1cm HS (-2), membrane(+) INV (06/19): TC: 13800 , N:82,L:22 , Hb : 11.1 Plt : 234000 , PC: 1-2, EC: 2-3 RBS: 84, RFT: Ur/Cr: 16/0.5, Na/K: 135/4.1 PT/INR: 14/1.0 Last Scan (06/19): SLIUP at 31 WOG, cephalic, plt : anterior UUS, AFI: 11cm , EFW: 1.8kg She received 1 dose of Inj Dexamethasone at 10pm Plan: close feto maternal monitoring 10/6/2024 22

23. Hari Maya Tamang 25yrs G2P1L1 at 38 weeks and 2 days of gestation in LPOL with SGA C/O: Amenorrhoea for 9 months, pain abdomen for 10 hours and perceiving adequate fetal movements O/E: GC: Fair, PIE: Nil, Vitals: stable P/A: uterus term size, cephalic, longitudinal, FHS+, contraction (25s,30s,30s) P/V: cervix soft, central, 50% effaced, os 2cm, membrane +, HS-1 INV (06/19): TC: 12900 , N:80,L:13, Hb : 14.4 Plt : 205000 , RBS : 102, RFT: Ur/Cr: 26/0.6, Na/K: 135/4.1 PT/INR: 14/1.0 Last Scan (05/19): SLIUP at 34+3 WOG, cephalic, plt : posterior UUS, AFI: 10.9cm , EFW: 2.3kg, normal doppler study Plan: Inj. Oxytocin 2.5U in titrating dose 10/6/2024 23

24. 5 ) Mrs. Nira Gurung 25 years (LABOR ROOM) G3P2L1 at 33 weeks and 4 days of gestation with Syphilis with threatened preterm labor C/O: Amenorrhea for 7 and a half months, Pain abdomen for 2 days on and off and perceiving adequate fetal movements O/E: GC : Fair, PIE: Nil, Vitals: Stable P/A : uterus 32 weeks size , longitudinal, cephalic, FHS +, 140bpm, contraction + (10s,10s) P/S: cervix not visualized, curdy white discharge +, HVS taken, show + P/V: cervix soft, central, 30% effaced, os 1cm, HS (-3) Last scan(06/15): SLIUP at 32 WOG , cephalic, PLT : Anterior and UUS, EFW : 1.8kg, AFI: 17.5cm, BDP: 80.8mm INV: TC: 13200, N:73,L:23, Hb : 13.5 Plt : 241000, RBS : 78 RFT : Ur/Cr: 16/0.5, Na/K: 138/3.7 PT/INR: 14/1.0 PC: 2-4, EC: 2-3 VDRL with Titre : 1:16, TPHA: positive, VDRL: Reactive She received Inj Dexamethasone 6mg IM (2 doses) Plan: Close fetomaternal monitoring 10/6/2024 24

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