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Thursday, April 7, 2016

Case Presentation

A 24 yrs female from Boudha was admitted here on 23/8/2072 with

 C/O : Cessation of menstruation for 8 months generalised body swelling-15 days



History of present illness 


Caessation of menses – 8months


LMP (Last Menstural Period) :22nd Chaitra,2072  

EDD (Expected Date of Delivery) :29th Poush,2072 By Date: 34 wks+1 day

Generalised body swelling-15 days Started from lower limbs, gradually progressed to thighs, abdomen and face

Perceiving good fetal movement

Cough (+): on and off, non productive, no diurnal variation

No chest pain, shortness of breath, orthopnea

No Headache, epigastric pain, blurring of vision, high blood pressure

No per vaginal bleeding or leaking, no pain abdomen

Had taken iron and calcium

Had taken two doses of injection tetanus toxoid

Bowel/Bladder-Normal

Sleep/Appetite-Normal




Menstural History: 


Menarche at 16 years

Flow-3 days, Cycle-28+/-2 days,

Dysmenorrhoea (-)

IMB/Intermenstural Bleeding (-)

PCB/Post Coital Bleeding (-)


Obstetric history: 

Married for 2 years,

Primigravida




Contraceptive history:


Not used till date.


Past history:

No Hx of TB, DM, HTN & any surgical intervention done  




Family history: 


No Hx of DM, HTN, TB, twin pregnancy




Personal history:


Non-vegetarian

Does not smoke and consume alcohol




Allergic history :


Not known till date 




On Examination:


General Condition = Fair, facial puffiness present

Bilateral pitting edema present over lower limbs

Pallor(+)

Icterus (-)


Vitals:

Pulse : 82 beats/min

BP:140/90mmhg

Temperature : 97 degree Farhenheit

Respiration Rate : 22 breaths/min



Chest:

Bilateral Vesicular Breath Sound

No added Sound


CVS:

1st and 2nd heart sound

No murmurs

Per-Abdominal Examination:

Inspection:

Abdomen distended up to midway between umbilicus and xiphisternum

Linea nigara and striae gravidarum seen

No visible peristalsis or pulsation seen

Flanks were full

All quadrants moving symmetrically with respiration




Palpation: 

Symphysio-fundal height 32cm 

Uterus 32 wk size

Longitudinal lie

Cephalic presentation,free

Contraction absent

FHS-140 beats/min

Fundal grip-soft,broad-suggestive of fetal buttocks

Right  lateral grip-curved,resistant-suggestive of fetal back

Left  lateral grip-irregular,knob like structure suggestive of fetal back

Per-Vaginal Examination:

No loss

Provisional diagnosis: 

Primi at 34weeks+1day period of gestation with generalised body swelling

Advice: 

Admission for observation and furthur evaluation all ANC and PET(Pre-Eclampsia Test) investigation

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