Case of uterine fibroid and RHD on pregnancy.

Sharing experience about patient management, which can help improving health care,
In this regard Sharing my interesting case can be useful to my fellow physicians who will have access on the case that I am now Sharing. So the presenting symptoms of the

1. 51 Y.O G 4 P 4 00 4 ADMITTED WITH SYMPTOMATIC UTERINE LEIOMYOMA SCHEDULED FOR TAH+BS TODAY ID 633054 she come complaining of pv bleeding like menses twice a month progressively exacerbated by heavy lifting associated with pain radiating to the back , -ROS= vaginal bleeding, urge and urgency ATCDs: G4P4004 uneventfully multinodular goiter since january No Hx of Allergy reported. P/E: VS: BP=11 9 / 52 mmHg, HR= 81 bpm, T= 36.4, RR= 18c/min, O2 sat= 98% in RA, CNS= Fully awake, GCS=15/15 CVS= Warm extremities, regular S1 & S2, No added sounds RS= clear lungs abdomen not distended fatt, slightly palpable mass in hypogastric GUS: bleeding pv MSK= no oedema GYN U/S: fundal myometrial leiomyoma with 6cmx5cm previous ct scan& MRI revealed huge focal fundal myometrial fibroid, ovary normal thyroid u/s: multinodular goiter Labs Inv: FBC: Hb= PLT= BGRh= Hep BsAg= Glyc= HIV: Ass: 51 Y.O G 4 P 4 00 4 admitted with symptomatic leiomyoma with pv bleeding, pelvic fullness and pain radiating in the back. on b/c of multinodular goiter Plan: Admit in ward2 Anesthesia visit blood booking laparotomy today for TAH+BS Evolution: Stable Vitals

2. 19 Y.O G 1 P AT 40 W 1 D BY DATES ON B /C OF RHD 686260 Cc: gush of clear fluid pv symptoms started 14hrs prior to our admission with spontaneous with gush of fluid paravaginally progressively increasing. associated with lumbopelvic pain. ROS: gush of fluid, no pv bleeding, quickening+, G&O Hx: G 1 P0, LMP= 1 3 /0 8 /2022 GA= 40 W 1 D, Had 3 x ANC at HC , TORCH (-) PMHx: Rheumatic heart disease since 2015 on captopril12.5mg tds, lasix40mg od, and penicillin V 250mg BID PSH: heart surgery for valve replacement P/E : BP 1 19 / 52 ,HR: 99 bpm T:36., spo2= 9 6 % General status : GOOD CVS : chest scar , holosystolic murmur 3/6 S1&S2: well audible regular RS : bilateral air entry Clear lungs Abd : gravidic, SFH: 28 cm ,FHR= 135 , with false UC - dve= - cervix at 4cm , 50% effaced, anterior, soft , station at-2, head not engaged, membrane ruptured, pooling test + MSK: normal no pedal edema Obst U/S : SIUP, cephalic , FHR= 1 35 , AFI= 2.4 cm, BPP= 8/8, ,placenta: anterior fundic , EFW= 3. 2 KGS EGA 38W1D Labs: : Hb : Plt : BG&RH= HIV -, hep b,? Glycemia: Assess: 19 Y.O G1P0 AT 40W1D by dates on b/c of RHD, repaired valve with features of PROM in latent phase of labor. Plan : Admit in ward2 Anesthesia visit emergency c/s FP: implanon Evolution : Stable Vitals FP: Implanon c/s done with good out come