ALIS Grand Conference (Syphilis) on September 19, 2024.pptx

A presentation of a pregnant patient who presented with Syphilis Infection.

1. M.A. 24 years old Married Brgy . Sto . Tomas, Barotac Viejo Chief Complaint: labor pains

2. HISTORY OF PRESENT ILLNESS 5 months PTC, Amenorrhea Prenatal visit was done at LHC Prescribed with multivitamins and folic acid 1 month PTC, requested with labs Anti-TP revealed positive Subsequently referred to this institution, but no consult was done

3. HISTORY OF PRESENT ILLNESS DOC, The patient noted increased frequency and duration of uterine contractions 1 st prenatal check up done at OPD Labs brought: (+) Anti-TP HBsAg - Nonreactive

4. HISTORY OF PRESENT ILLNESS At OPD Attached to the fetal monitor FHB – 140s IE 6cm cervical dilatation 60% effaced cephalic at Station -1 intact membranes

5. For admission Administration of Penicillin G 2.4mU IM as single dose Patient referred to Dept of IM for co management re: + Anti-TP test Deliver the baby at the Emergency room-isolation PLANS

6. PAST MEDICAL HISTORY (-) Hypertension (-) Diabetes Mellitus (-) Bronchial Asthma (-) Food and drug allergies

7. FAMILY HISTORY (-) Hypertension (-) Diabetes Mellitus (-) Bronchial Asthma (-) Food and drug allergies

8. PERSONAL, SOCIAL AND ENVIRONMENTAL HISTORY Housewife Nonsmoker Non alcohol beverage drinker

9. OB score: G3P2 (2002) OB HISTORY LMP - May 30, 2015 PNMP – April 28, 2015 EDC – March 8, 2016 AOG - 38 2/7 weeks Date Age Type of Delivery Place of Delivery Complication G1 – 2011 20 NSVD – Baby Boy, Full term Btac . Viejo LHC None G2 - 2013 22 NSVD – Baby Girl, Full term Btac. Viejo LHC None

10. No Coitarche – 20 years old No. of sexual partner – 1 (husband) She claimed that her husband has extramarital affairs OB HISTORY Menarche – 15 years old Interval – regular Duration – 5 days Amount – 3 pads per day Symptoms – (+) dysmenorrhea

11. PRENATAL HISTORY 1 st PNCU ( Local Health Center ) ? 20weeks AOG Multivitamins + FA was given Labs requested 2 nd PNCU (Local Health Center) 34 weeks AOG labs complied: Anti-TP, HBsAg , CBC, U/A Result: (+) Anti-TP HBsAg - nonreactive no ultrasound referred to tertiary hospital

12. PHYSICAL EXAMINATION Vital Signs: BP- 100/70 CR- 92 RR- 24 Temp – 36.7 Weight: 60kg Height: 5’2”

13. PHYSICAL EXAMINATION General Survey Awake Conscious Ambulatory not in cardiopulmonary distress Skin Uniform in color no lesions (-) chancre

14. PHYSICAL EXAMINATION HEENT Anicteric dirty sclerae pinkish conjuctiva moist buccal mucosa no oral lesions non-inflamed tonsils no cervical lymphadenopathy

15. PHYSICAL EXAMINATION Chest Symmetrical in shape no masses noted symmetrical chest expansion (-) retraction equal tactile fremitus Resonant bronchovesicular breath sounds Heart Adynamic precordium normal cardiac rate and rhythm prominent S1 and S2 sounds (-) murmur

16. PHYSICAL EXAMINATION Abdomen Globular gravid abdomen striae gravidarum Linea nigra multiple stretch marks no scars and lesions noted Leopold’s maneuver I: breech II: fetal back at left III: engaged IV: occiput FHB: 140s at LLQ FH: 30cm

17. PHYSICAL EXAMINATION Extremities Full ROMs (-) swelling/tenderness Pink nailbeds Capillary refill <2secs No peripheral lesions

18. PELVIC EXAMINATION I Normal external genitalia (-) lesions or masses SE Not assessed IE 6cm dilatation 60% effaced St -1 Cephalic Intact membranes

19. G3P2 (2002) Pregnancy Uterine 38 2/7 wks AOG; Cephalic in labor; Early Latent Syphilis Infection ASSESSMENT

20. COMPLETE BLOOD COUNT Complete Blood Count Hemoglobin Hematocrit Red Blood Cell White Blood Cell 114 0.33 3.96 12.68 g/L L/L 3.96 12.68 Normal Values 120-160 0.37-0.47 4.2-5.4 4.5-11 Differential Count Neutrophil Number Fraction Segmenters Lymphocyte Eosinophils Monocyte Basophil 0.78 0.17 0.01 0.04 0.00 0.50 – 0.70 0.20 – 0.40 0.01 – 0.04 0.04 – 0.08 0.00 – 0.01 Blood Indices MCH MCV MCHC 28.80 82.10 35.10 Fmol fL g/L 27.27 – 33.27 83.89 – 100.7 31.85 – 33.87 Platelet 217 10^9/L 150-450 Blood Type Rh “O” Positive

21. URINALYSIS Physical Properties Color Transparency Reaction (pH) Specific gravity Straw Hazy 6.5 1.020 Chemical Test Sugar Albumin Neg (-) Neg (-) Microscopic Findings Pus cells Red blood cells 2-5/ hpf 15-20/ hpf Cast None Crystal Amorphous Urates Squamous E. cells Round E. cells Mucus threads Few Many Many Many CLINICAL CHEMISTRY BUN 3.40 mmol /L 2.5-6.4 Creatinine 62.80 Umol /L 53-115 Sodium 135.90 mmol /L 135-148 Potassium 3.70 Mmol /L 3.5-5.3 ANTI-HIV 1 & 2 ANTI HIV 1 & 2 Nonreactive Method Used Immunochromatography HBsAg HBsAg Nonreactive Method Used Immunochromatography

22. Labor Graphic Chart C E R V I C A L D I L A T A T I O N 10 9 8 7 6 5 4 3 2 1 -5 -4 -3 -2 -1 +1 +2 +3 +4 +5

23. G3P3 (3003) Pregnancy Uterine delivered to a live term baby girl with BW 2500g AS 9,10 CAOG 38 weeks in cephalic presentation via normal spontaneous vaginal delivery s/p right mediolateral episiotomy and repair; Early Latent Syphilis Infection ASSESSMENT

24. A: G3P3 (3003) Pregnancy Uterine delivered to a live term baby girl with BW 2500g AS 9,10 CAOG 38 weeks in cephalic presentation via normal spontaneous vaginal delivery s/p right mediolateral episiotomy and repair; Syphilis Infection P: IVF: D5LR 1L + 10u oxytocin @ 30gtts/min Meds: 1) Co- amoxiclav 625mg/tab 1 tab BID x 7days 2) Naproxen Na 550mg/tab 1 tab BID x 4 doses 3) Multivitamins + Iron tablet OD 4) 10 units oxytocin 1 amp deep IM now Uterine massage Periheat for 15 mins OD COURSE IN THE WARDS Post Partum Day 1 BP 100/70 CR 86 RR 20 T 36.5 (+) minimal bleeding (+) Well contracted uterus Clear breath sounds Pen G given BABY’S DATA (+) jaundice – 3 rd and 4 th day of life Penicillin G 50, 000 units given q 12 RPR – negative TPHA – nonreactive Lumbar Puncture - elevated protein

25. A: G3P3 (3003) Pregnancy Uterine delivered to a live term baby girl with BW 2500g AS 9,10 CAOG 38 weeks in cephalic presentation via normal spontaneous vaginal delivery s/p right mediolateral episiotomy and repair; Syphilis Infection P: Increase oral fluid intake Feminine wash BID d/c IVF COURSE AT THE WARDS Post Partum Day 2 BP 100/70 CR 78 RR 19 T 36.0 (+) minimal bleeding Anti-HIV 1 & 2 - negative

26. A: G3P3 (3003) Pregnancy Uterine delivered to a live term baby girl with BW 2500g AS 9,10 CAOG 38 weeks in cephalic presentation via normal spontaneous vaginal delivery s/p right mediolateral episiotomy and repair; Syphilis Infection P: May go home Instructions given OPD ff-up COURSE AT THE WARDS Post Partum Day 3-7 BP 100/70 CR 81 RR 20 T 36.3 Randox Syphilis TPHA – negative BABY’S DATA Still admitted For completion of antibiotics (Penicillin G)

27. G3P3 (3003) Pregnancy Uterine delivered to a live term baby girl with BW 2500g AS 9,10 CAOG 38 weeks in cephalic presentation via normal spontaneous vaginal delivery s/p right mediolateral episiotomy and repair FINAL DIAGNOSIS