Premature rupture of Membrane- Case .pptx

Premature Rupture of membrane

1. PREMATURE RUPTURE OF MEMBRANE

2. Particulars of the patient Particulars of the patient Name Mrs. Sima . Age: 23years . Sex: Female. Marital status. Married. Religion: Islam. Occupation: Housewife. Husband name: Md. Saad bin Nijam Addra: Kamatangaria , bhurungamari , Kuigram Date and time of admission : 6/7/23. at 11.47pm Dale and time if examination: 7/7/23 at 12.05pm.

3. Chief Complaints Chief Complaints; History of pregnancy for 34wks Per vaginal watery discharge for 16 hours.

4. History of present illness: According to the statement of the patient, she is amenorrhoeic for about 34 wks and had regular ante natal check up. Her pregnancy was uneventful up to 33 wks. One day ago she noticed sudden gush of per vaginal watery discharge while sleeping at night. It was moderate in amount ,clear ,odorless and gradually decreasing in amount but persisted as leaking. The amount of leaking in increased on walking and change of posture. The discharge is not associated with lower abdominal pain, back pain ,fever and vulvo -vaginal itching. She did not complaint of any urinary problem like urgency, frequency and dysuria, per vaginal bleeding and abdominal trauma. With these complaints she is admitted into Rangpur Community Medical Hospital for better management

5. Family history family history: None of her family members are suffering from HTN, DM, Br Asthma. Her parents and 2 small brothers are alive and living e healthy life. Her first children was died only after 3 hours of birth due to prematurity caused by severe oligohydramnios due to Prelabour rupture of membrane.

6. Personal history She doesn’t have any habit of taking betel nut, smoking or alcohol consumption.

7. Drug history: There is no significant drug history. Allergic history: Not significant

8. Immunization history She is well immunized according to EPI schedule. She has got TT vaccine in full dose

9. Socioeconomic history she belongs to middle class family, uses sanitary latrine and drinks safe water.

10. Obstetric history. Married for: 4 years Para: 1(c/s)-1(perinatal death)+0 Gravida: 2 nd Gravida

11. Obstetric chart. Number of child. Mode of delivery. Date of delivery Place of delivery. Status of the baby 01 14-8-20 Cesarean section Kurigram sadar hospital Died after three hours of birth due premature baby caused by severe oligohydramnios e prom

12. Menstrual history. Age of menarche: 12 years Menstrual period: 3-4 years Menstrual cycle: 28+-3days LMP: 11-11-22 EDD: 18-8-23

13. Contraceptive history: She take combined oral pill for birth spacing 2 years back.

14. General physical examination: Appearance: anxious Body build: average Nutritional status average Decubitus: on choice Anemia: mildly anemic Jaundice: not icteric. Cyanosis: absent Oedema: absent Dehydration: absent Blood pressure: 130/80 mm of hg Pulse: 82 beats/ minute Temperature: normal Respiratory rate: 19 breaths/min.

15. Systemic examination Breast: Normal according to third trimester changes Cardio vascular system: Normal. Respiratory system: Normal.

16. Abdominal examination: Inspection: abdomen is uniformly enlarged umbilicus is centrally placed, striae gravidarum and linea Niagra are present. There is a transverse incisional scar in the lower abdomen. Palpation: Abdomen is soft relaxed and nontender. Height of the uterus is about 32 weeks size and the symphysis fundal height is 32 centimeter. Palpation reveals the lie of the fetus is longitudinal, cephalic presentation and head is not engaged. Fetal parts are easily felt. Fast pelvic grip: smooth hard smaller ballotable head felt in the lower uterine segment. second pelvic grip: The head is not engage, liquor volume is less than adequate, the abdominal girth is about 96 centimeter, uterine contraction are absent.

17. Auscultation: fetal heart sounds heard at the midpoint of the spino umbilical line, fetal heart rate is about 140 beats per minute On Per Vaginal examination :On inspection: Vulval pad is soaked with watery discharge which is clear and not foul smelling. Per speculum examination: cervix is patulas and centrally placed. Liquor is escaping out through the external os while coughing.  (Valsalva maneuver ). Cervical os is closed and there is no evidence of cord prolapse.(  Valsalva maneuver ).

18. Salient Feature Mrs Sima , 23 years old, second gravida, para 1 (VD)-1(Perinatal death).+0, a housewife of middle socioeconomic class family, hailing from kurigram , got herself admitted in this hospital on ...with the complaints of • Pregnancy for 34 weeks • Per vaginal watery discharge for one day According to the statement of the patient she was a regularly menstruating woman with aver- age flow and duration. Her LMP was on 11/11/22 and accordingly her EDD will be on 18/08/23. Her pregnancy period was uneventful up to 34 weeks. One day ago she noticed sudden gush of vaginal watery discharge while sleeping at night. It was initially moderate in amount, clear, non odorous and gradually decreasing in amount but persisted as leaking. The amount of leakage is increased on walking and change of posture. The discharge is not associated with lower abdominal pain, fever and vulvo vaginal itching. She did not complaint of any urinary problem like urgency, frequency and dysuria. Regarding her obstetric history she is married for 4 years. She delivered a premature baby by cesarean section at kurigram Sadar Hospital but unfortunately the baby was died due to prematurity caused by severe oligohydramnios with prom Regarding her personal history she is normotensive, non diabetic, non smoker and non alcoholic. She was anxious but cooperative with average body built. Her pulse is 82 b/min, BP is 130 /80 mm Hg, temperature 98.40 F. She is mildly anemic, non icteric and edema is absent. On Per Abdominal examination: Uterus is uniformly enlarged, umbilicus is centrally placed. Linea nigra and striae gravidarum are present. Uterus is soft, relaxed and non tender. No contraction is present. SFH is 32 cm, abdominal girth is 82 cm. There is a single fetus, longitudinal lie, cephalic presentation. Liquor volume seems to be less than adequate. Fetal parts are easily felt. FHR is 140 b/min. On Per Vaginal examination :On inspection: Vulval pad is soaked with watery discharge which is clear and not foul smelling. On gentle sterile speculum examination: Liquor is escaping out through the external os while coughing. Cervical os is closed and there is no evidence of cord prolapse.So , from history and clinical examination my provisional diagnosis she is a case of secondgravida with 34 weeks of pregnancy with preterm  prelabour rupture of membrane.

19. History of present illness: According to the statement of the patient according to the statement of the patient She is amenorrhoeic for about 34 weeks and had regular ante natal checkup. Her pregnancy period was uneventful upto 33 weeks. One day ago she noticed sudden gush of vaginal watery discharge while sleeping at night. It was initially moder- ate in amount, clear, non odorous and gradually decreasing in amount but persisted as leaking. The amount of leakage is increased on walking and change of posture. The discharge is not associated with lower abdominal pain, fever and vulvo vaginal itching. She did not complaint of any urinary problem like urgency, frequency and dysuria. With these complaints she is admitted in this hospital for better management. She noticed watery discharge from her vagina without any pain for last 2 hours the fluiders clear odourless and about two cups in amount she feels good fetal movement without any lower abdominal pain or back pain she had no history of fever and any urinary Aur GIT symptoms she also had no permaginal bleeding vaginal itching or smiley discharge no recent abdominal from and no previous similar episodes she animated to rangpur comedy Medical College Hospital for better management she was a regularly menstruating woman with average flow and duration. Her LMP was on ... and accordingly her EDD will be on Her pregnancywas also dated by early US. She was on regular antenatal check up and was duly immunized against teta -nus. Her pregnancy period was uneventful upto 31 weeks. One day ago she noticed sudden gush of vaginal watery discharge while sleeping at night. It was initially moder- ate in amount, clear, non odorous and gradually decreasing in amount but persisted as leaking. The amount of leakage is increased on walking and change of posture. The discharge is not associated with lower abdominal pain, fever and vulvo vaginal itching. She did not complaint of any urinary problem like urgency, frequency and dysuria. With these complaints she is admitted in this hospital for better management.