Name of the patient:

HC
Chief complaint:

This is 29 years old patient from Egypt, Gravida 2 para 1 with no previous miscarriages, at 19
weeks of gestation.
Admitted through ED with complaint of gush of fluid since 1 days, as well as lower abdominal
pain for 2 days for further management
The leaking began suddenly, lasting 1 hour, while she was doing normal house chores.
The fluid was clear, odourless, and large in volume (around 1 cup) with minimal bleeding. There
is no associated contraction pain, fever, foul smelling discharge or any urinary symptom.
There was no history of trauma or sexual intercourse.
Abdominal pain - started 2 days ago, it was sudden, woke her up from sleep, waxing and waning
involving the lower abdomen mainly, squeezing in nature (described as squeezing cramping
pain), no aggravating or reliving factors.

During Hospitalization
2nd trimester US was done and showed
Severe oligohydramnios deepest pocket 1.9 cm.
Presentation: Breech
Placental localization: Posterior placenta -low-lying 2.5 cm away from the internal os
Amniotic fluid ,Fetal heart beats are seen and recorded.
IUCD seen in anterior myometrium

She was kept for monitoring of CRP, Vital signs &Temperature chart
Analgesia PRN, hydration and she kept for observation

Current Pregnancy
Unplanned, it was conceived spontaneously. She was on IUCD for contraception
 LMP 23/11/2020 EDD by Ultrasound 20/08/2021

EDD by LMP 30/08/2021 Confirmed EDD 20/08/21

Booked her antenatal visits at 13 weeks of GA at: EPAU (early pregnancy assessment unit)
Her initial antenatal blood investigations done all came back normal
Routine Investigations: CBC, Rh-, FBS, Rubella, HBsAg, Hep B Hep C, Syphilis. Viral load for hep
1st trimester US done: in EPAU and correlating with her LMP
During her 1st trimester: She did not experience any vaginal bleeding or discharge , abdominal
pain, vomiting or any urinary symptoms. .
Urine culture done and was negative

Medications (supplements) : Folic acid, Iron.

2nd trimester:
 US for anomalies done: done during this admission
 Screening for diabetes not done since she is 19 weeks only

Past obstetric history:

No previous Miscarriage or ectopic pregnancies.

Gynecological history:
Menstrual history
She attained menarche at the age of 12 years.
Her Menstrual cycle was, regular lasting 7 days, moderate flow, no dysmenorrhea
ANY Gynae issues: None
Contraceptive history: IUCD Since 2019
Pap smear:/. No
Past medical history:
Insignificant
Past Surgical history:
Insignificant

Family history:
Insignificant

Current Medications:

Allergies:
No Known allergies

Blood group:
Rh positive

Social history:

 Patient is an engineer. No consanguinity. She mentioned that her pregnancy has affected her
psychologically and she is not ready to have a baby. She was crying and shouting requesting
Termination of Pregnancy. Her husband is also keen to terminate it. Her diet consists of both
home-cooked meals and occasional junk meals. She walks for exercise. She and her husband
don’t smoke, and no alcohol consumption.

General examination
Patient is lying down comfortably in supine position on bed .
Alert, oriented. She is moderately built.
no jaundice in sclera , no pallor on conjunctiva.

Hands : warm,no pallor on the palms and nail bed for both hands.
Eye :no jaundice in sclera , no pallor on conjunctiva.
Oral cavity :tongue pink and moist ,no glossitis ,tonsils not enlarge.
Overall oral hygiene good.
Neck :no thyroid swelling.
Breast :no lumps ,no nipple retraction, no nipple discharge.
Pedal edema :mild present.

Vital signs :
 Temperature:37 ℃
 Pulse:120 beats per minutes,regular rhythm,normal volume and character
 Respiratory rate :22 breath per minutes
 Blood pressure :110/100mmHg taken in sitting position

Systemic Examination
 Cardiovascular system:S1 andS2 heard.
No murmurs
 Respiratory system :Normal vesicular breath sounds heard.
No adventitious sounds

Obstetric Examination
Inspection:
 Abdomen is symmetrical, flank full.
 striae gravidarum is present. No Linea nigra
 Umbilicus is centrally placed and flat.
 All quadrants move symmetrically with respiration.
 No obvious fetal movements.
 No scars
 Hernia orifices are intact.
On Palpation:
There was no any areas of tenderness on Superficial palpation
Deep palpation was not done
 Symphysio fundal height: 16cm

 Auscultation: fetal sounds are heard right lower quadrant.

 LOWER LIMBS
 No Lower limb edema
 No Varicose veins
 No Signs of DVT (skin changes / heat / swelling / tenderness of calf muscle /
peripheral pulses)

Speculum exam: cervix looks open, small cervical polyp was seen, clear liquor was seen+++

Summary:

This is a 29 years old from egypt, Gravida 2 para 1 with no previous miscarriages, at 19 weeks
of gestation. Admitted through ED as a case of Inevitable Miscarriage with Previable rupture of
membranes

Patient was counselled that severe oligohydramnios is not an indication for termination of pregnancy
and that a decision has to be made from ethical committee.

Patient was discharged against Medical advice.

And was counselled that if she develops any signs of chorioamnionitis, like fever or labor pain she should
come to the ED. As well as the need for follow up in Fetal Maternal Unit .