lscs OBG CASE PRESENTATION harsha.pptx

Case presentation

1. OBG CASE PRESENTATION PRESENTER : Harsha BJ MENTORS : Dr. Mangala Dr. Hiranmayi

2. Patient Particulars : NAME : Mrs. ABC AGE : 28y ADDRESS : Magadi , Bengaluru EDUCATION : BA OCCUPATION : Teacher HUSBAND DETAILS : XYZ, 30y, businessman, B.Com , 40,000/month. SOCIOECONOMIC STATUS : upper middle LMP : 07/08/2019 EDD : 14/05/2020 GESTATIONAL AGE : 38 weeks 7 days DOA : 07/05/2020 DOE : 07/05/2020

3. 6 G2P1L1A0 with 9 months of amenorrhea came for regular antenatal check-up with no other complaints. No history of pain abdomen, head ache, blurring of vision, swelling of legs, bleed or leak PV. Fetal movements well perceived. OBSTETRIC HISTORY : Index : G2P1L1A0 HISTORY OF PRESENT PREGNANCY : LMP : 07/08/2019 EDD : 14/05/2020 Booked case at Vani Vilas hospital, Bengaluru. FIRST TRIMESTER : Pregnancy was confirmed after one month of missed periods at hospital by UPT. History of spontaneous conception. 1st trimester scan (dating scan) was done and found to be normal and corresponding with dates.

4. Folic acid tablets were taken. No h/o burning micturition. No h/o fever with rashes, excessive vomiting. No h/o spotting or bleeding per vagina. No h/o pain abdomen. No h/o exposure to radiation and drug intake. Regular ANC was done, weight gain was 1kg. SECOND TRIMESTER : Quickening was felt at 5 th month. 2nd trimester scan ( Anamoly scan) was done and found to be normal. 2 doses tetanus toxoid were taken.

5. Iron and calcium tablets taken, weight gain was 6 kg. No h/o fever, increased frequency/burning of micturition. No h/o pedal edema , blurring of vision, headache. No h/o of pain abdomen, leaking or bleeding per vagina. THIRD TRIMESTER : Continued perception of fetal movements. Iron and calcium tablets taken, weight gain was 5 kg. Obstetric scan was done and found to be normal. No h/o fever, increased frequency/burning of micturition. No h/o pedal edema , blurring of vision, headache. No h/o of pain abdomen, leaking or bleeding per vagina.

6. HISTORY OF PREVIOUS PREGNANCY : FIRST PREGNANCY Antenatal events - uneventful, booked case at government hospital. Perinatal details -Term baby, institutional delivery by caesarean section 3 years back on 05/05/2017. Indication : breech presentation with fetal distress (MSAF) Emergency LSCS at 39 weeks when patient had come with decreased perception of fetal movements. Baby cried immediately after birth, breast fed after 1hr, no h/o NICU admission. Outcome : Alive boy baby of 3kg birth weight, currently healthy and doing well. No fever or wound discharge in post operative period, sutures removed on 7 th day. Postnatal events – uneventful MENSTRUAL HISTORY : Age of attainment of menarche -13 years Regular cycle of 28 to 30 days, flow for 4-5 days, changes 2-3 pads per day. Not associated with dysmenorrhea, No h/o of passage of clots.

7. PAST HISTORY : No h/o blood transfusion in the past No h/o any recent surgery Not known case of Hypertension, Diabetes mellitus, asthma, TB, epilepsy. MARITAL HISTORY : Married life of 5 years and Non consanguineous marriage. CONTRACEPTIVE HISTORY : oral contraceptive pills before first pregnancy later barrier method (condom). FAMILY HISTORY : No history bleeding disorder. No history of children's with chromosomal anamoly /birth defect. No history of twining in the family. No h/o Hypertension, Diabetes mellitus, asthma, TB, epilepsy.

8. PERSONAL HISTORY : Diet - mixed Appetite - normal Sleep - adequate Bowel and bladder - regular No history of substance abuse GENERAL PHYSICAL EXAMINATION Patient is conscious, cooperative well oriented to time, place, and person Vitals : Patient is afebrile Pulse - 90/min regular rhythm, normal volume, normal character, vessel wall is not palpable and all peripheral pulse are felt. Blood pressure -120/80mmhg right arm, supine position. Respiratory rate -16/minute No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema .

9. Height -160 cm Pre pregnancy Weight - 61 kg Present weight - 73 kg BMI – 23.8 kg/ m.sq HEAD TO TOE EXAMINATION : Thyroid appears normal. Breast examination shows normal changes of pregnancy. Spine appears normal. OBSTETRIC EXAMINATION Position - supine with legs semiflexed INSPECTION Shape of the abdomen - distended and appears longitudinally oval with fullness of flanks. Corresponding quadrants moves equally with respiration. Umbilicus is central and everted. Linea nigra and stria gravidarum present. No sinuses or dilated veins can be seen. Hernial orifices are intact.

10. A horizontal scar of 10 cm noted about 3 cm above the pubic symphysis, healed by primary intention without hypertrophy and keloid formation. PALPATION : No local rise of temperature or tenderness with relaxed uterus. Abdominal girth is 102 cm, at the level of umbilicus. Fundal height corresponds to period of gestation (32-34 weeks with flanks full) Symphysiofundal height is 34cm, corresponds to gestational age. OBSTETRIC GRIPS : Fundal grip : broad, soft, irregular mass suggestive of breech. Right Lateral grip : uniform curved resistance suggestive of spine. Left lateral grip : multiple knob like structures suggestive of fetal limb parts. 1 st pelvic grip : hard non ballotable mass suggestive of fetal head. 2 nd pelvic grip : fingers converge. No scar tenderness. AUSCULTATION : FHS heard along right spinoumbilical line, rate - 142/min

11. SYSTEMIC EXAMINATION : Cardiovascular system: S1, S2 heard, no murmurs heard. Respiratory system : Normal vesicular breaths sound. No added sounds. Central nervous system : clinically no abnormality detected. PROVISONAL DIAGNOSIS : A 28 year old lady with obstetric index G2P1L1A0 with 38 weeks 7 days period of gestation with live singleton intrauterine pregnancy, longitudinal lie and cephalic presentation with previous caesarean section, not in labour.

12. Follow ACOG Practice Guidelines Education And Counseling Preconceptionally Provide ACOG Patient Pamphlet Early During Prenatal Care Develop Preliminary Plan Revisit At Least Each Trimester Be Willing To Alter Decision Have Facilities Availability Risk Assessment

13. Review Previous Operative Note(s) Review Relative And Absolute Contraindications Reconsider Risks As Pregnancy Progresses Tread Carefully: >1 Prior Transverse CD, Unknown Incision, Twins, Macrosomia Labor And Delivery Cautions For Induction— unfavorable Cervix, High Station Consider AROM Avoid Prostaglandins Respect Oxytocin—know When To Quit Beware Of Abnormal Labor Progress Respect EFM Pattern Abnormalities Know When To Abandon A Trial Of Labor

14. Thank you