GYNAE UNIT 2
FMCH
CLINICAL CASE
PRESENTATION
Dr S.M. SHAHRIAR ISLAM
INTERN DOCTOR
FMCH
PARTICULARS OF THE PATIENT
NAME OF THE PATIENT : MRS. RUNA
AKTER
AGE : 32 YEARS
RELIGION : ISLAM
OCCUPATION : HOME-MAKER
HUSBAND'S NAME : MOSHARROF
HOSSAIN
HUSBAND'S OCCUPATION : BUS DRIVER
ADDRESS : BOLPUR, SADARPUR,
FARIDPUR.
DATE OF ADMISSION : 06.09.20 AT 05:40
P.M
CHIEF COMPLAINTS
- Pregnancy for 30+ weeks
- Less fetal movement for 24 hours
HISTORY OF PRESENT ILLNESS
According to the statement of the
patient, she was pregnant for 30+
weeks. It was her unplanned pregnancy.
She didn’t receive regular antenatal
check-up. Her L.M.P was on 22.01.20
and E.D.D would be on 29.10.20
accordingly. Her pregnancy was
uneventful till 30 weeks. Then she
noticed less fetal movement for 24
hours.
With these complaints, she consulted a
physician at a private clinic where a USG was
done. According to the USG she was diagnosed
as a case of 30+ weeks of pregnancy with IUFD
and she was referred to FMCH for better
management. She had undergone caesarean
section 6 years ago due to postdated
pregnancy with prolonged labour. The patient
has no history of per-vaginal bleeding, high
grade fever, hepatitis, infuenza, or any other
infection. She has no history of DM, Asthma or
heart disease.
OBSTETRIC HISTORY
Married for : 15 years
Married at : 17 years
Para : 2 (1 NVD, 1 C/S) + 1
(abortion)
Gravida : 4th
Age of last child : 6 years
MENSTRUAL HISTORY
Menstrual Cycle : Regular
Menstrual Flow : Average
Menstrual Period : 3-5 days
L.M.P : 22.01.20
E.D.D : 29.10.20
OBSTETRIC CHART
N
Year of Duration Antenatal Mode and
O of Complicatio
Complication
pregnan Check-up place of s Puerperiu Outcom
pregnan ns
cy delivery m
cy of during e
delivery
pregnancy
1 2008 39 Infrequen No Home No Normal Alive
weeks t NVD
2 2014 42 Infrequen No FMCH No Normal Alive
weeks t C/S
HISTORY OF PAST ILLNESS
She had undergone caesarean section 6
years back. She has no history of any
other systemic illness.
FAMILY HISTORY
No significant family history.
PERSONAL HISTORY
Patient is non-smoker, non-alcoholic, she
does not use tobacco, betel nut or betel
leaves.
CONTRACEPTIVE HISTORY
She only took Oral Contraceptive Pills
occasionally.
IMMUNIZATION HISTORY
She is not immunized against Tetanus.
SOCIOECONOMIC HISTORY
The patient came from a lower middle
class family. She lives in tin-shed house,
drinks tube well water and uses sanitary
latrine.
PHYSICAL EXAMINATION
1. GENERAL EXAMINATION:
APPEARANCE : Ill looking, anxious
DECUBITUS : Supine
BODY BUILT : Average
CO-OPERATION : Cooperative
ANAEMIA : Mildly anaemic
JAUNDICE : Absent
CYANOSIS : Absent
EDEMA : Absent
DEHYDRATION : Absent
KOILONYCHIA : Absent
LEUCONYCHIA : Absent
PULSE RATE : 85 beats/min
BLOOD PRESSURE : 100/70 mmHg
RESPIRATORY RATE : 20 breaths/min
TEMPERATURE : 98◦ F
LYMPH NODE : Not palpable
THYROID GLAND : Not enlarged
2. EXAMINATION OF THE BREAST AND AXILLA :
- Both breasts looked symmetrical
- Nipple and areola are enlarged
- Development of secondary areola
- Prominence of Montgomery Tubercle
- No tenderness or no palpable lump was found on breast
or axilla
3. PER ABDOMINAL EXAMINATION :
INSPECTION:
Abdomen is slightly distended.
Umbilicus is centrally placed, everted.
Linea nigra & Stria Gravidarum present.
PALPATION :
• Abdomen is soft and non-tender.
• No local rise of temperature.
• Fundal grip : A soft, broad, irregular mass was palpable.
• Lateral Grip : A smooth, curved, resistant surface was felt at
left lateral side of Umbilicus & some nob like structures were
felt at right.
• First pelvic grip : Hard, smooth, round, ballotable part
was found.
• Second pelvic grip : Presenting part found not engaged.
• Fetal movement : Absent.
ASCULTATION :
- Fetal heart sound wasn't audible.
4. PER-VAGINAL EXAMINATION :
• INSPECTION - Vulva and vagina has normal appearance.
• BIMANUAL EXAMINATION – Not done.
• SPECULUM EXAMINATION – Not done.
5. SYSTEMIC EXAMINATION :
CARDIOVASCULAR SYSTEM - Both 1st and 2nd heart sound is audible
in all 4 auscultatory areas.
No added sound present.
RESPIRATORY SYSTEM :
Breath sound is vesicular and no added sound present.
Other systemic examinations revealed no abnormal findings.
SALIENT FEATURES
Mrs Runa, 32 years old normotensive, nondiabetic, muslim homemaker
hailing from sadarpur, faridpur was admitted to FMCH with the
complaints of pregnancy for 30+ weeks and less fetal movement for 24
hours. It was her unplanned pregnancy, she didn’t receive regular
antenatal check-up. She had undergone a caesarean section 6 years
back due to post-dated pregnancy with prolonged labour. Her L.M.P was
on 22th January 2020 and E.D.D would be on 29th October 2020. He
pregnancy was uneventful till 30 weeks. Then she felt less fetal
movement for 24 hours. And an USG was done at a private clinic which
revealed IUFD. Then she was referred to FMCH for better management.
On general examination, patient was ill-looking, anxious, mildly anaemic,
pulse rate 85 beats/min, Blood pressure 100/70 mm Hg, Respiratory rate
20 breaths/min. On abdominal examination, umbilicus was centrally
placed, everted. Linea nigra and Stria Gravidarum was present. Her
bowel and bladder habits are normal. Other systems reveal no
abnormalities.
CLINICAL DIAGNOSIS
A case of 4th gravida with 30+ weeks
pregnancy with IUFD with previous 1
caesarean section.
INVESTIGATIONS
CBC : Hb% : 12.2 gm/dl
TOTAL COUNT OF WBC : 12000
ESR : 14mm in 1st hour
Blood Grouping & Rh typing : A (+)ve
BT : Advised but not done
CT : Advised but not done
PT : Advised but not done
RBS : 6.5 mmol/l
HBsAg : (-)ve
VDRL : Non-reactive.
Urine R/M/E : Normal findings.
USG of pregnancy profile : reveals a case of IUD with 21+
weeks gestation period with cephalic presentation with
absent liquor.
Management
Diet : Normal
Tab. CIPROFLOXACIN 500 mg
1+0+1
Cap. ESOMEPRAZOLE 20 mg
1+0+1 Before meal
The patient was properly counselled about
the outcome and was given reassurance with
proper psychological support. An intracervical
Folley’s Catheter was placed to induce the
expulsion of the dead fetus.
ADVICE
The patient and her attendants were advised to
inform the duty doctors if any complains arise
giving special attention to :
-Per-vaginal bleeding
-Fever
-Labor pain
She was also advised to arrange 2 units of fresh
human blood.
THANK
YOU
