OG Cases

GOVERNMENT TIRUVANNAMALAI
MEDICAL COLLEGE
DEPARTMENT OF OBSTETRICS & GYNAECOLOGY
Anemia in Pregnancy
Mrs Tamilselvi, a 20 yrs old coming from keelpennathur, who is home maker, lower socio
economic class (obstretic score : primi) with 8 months of amenorrhoea came to OPD c/o
pain in the abdomen.
She is booked and immunised.
LMP 12/2/21
EDD 19/11/21
HOPI
Patient was apparently normal before one week after which she developed diffuse
abdominal pain.
Insidious in onset
Intermittent and non progressive in nature
H/O fatigue and lethargy for last one week
H/O headache
No H/O of blurring of vision
No H/O vomitting
No H/O reduced urinary output
No H/O breathelessness, palpitations and chest pain
No H/O pedal edema
No H/O fever with chills and rigor, burning micturition
No H/O passage of worms in stools
No H/O trauma, hemaptysis, hematemesis, malena
No H/O bleeding or leaking oer vagina
No H/O bleeding per rectum
No H/O hematuria, facial paffiness
Noh/O yellow discoloration of urine, skin or eyes
No H/O beeding disorder
No H/O evening rise in temperatures or contact with TB patients
No H/O prior blood transfusion
No H/O bleeding / draining PV
Fetal movements are well perceived
Past history
She is known case of asthmatic (not using inhaler now )
Not a K/C/O DM, HTN, TB, epilepsy, thyroid disorder and cardiovascular disorders
No H/O blood transfusion
No H/O recent surgeries
N/K/c/O =TB, epilepsy, HPT, asthma, thyroid diorder.
Menstual history
She attained menarchy at the age of 14 yrs.
Regular 28 days cycle, menstrating 3 days, changes 3 to 4 pads per day not associated with
clots and not associated with pain.
Marietal history
She married at the age of 19 yrs
Non consanguieous
No H/O consumption of OCP.
Obstretics history
Primi gravida
Pregnancy was confirmed by UPT at 6 weeks of amenorrhoea
Booked and immunised
First trimester
H/O spontaneous conception
Pregnancy detected at home with urine pregnancy test after one month of her missed
periods.
First dose of Td given
Dating scan done at 12th week
NT scan done
H/O breathelessness
No H/O fever with rashes
No H/O hyperemesis gravidarum
No H/O radiation exposure
No H/O drug intake
No H/O pain abdomen
No H/O bleeding PV, burning micturition
Second trimester
Quickening felt at 6th week
Second dose of Td given
Anamoly scan at 20th week
H/O easy Fatigubility
H/O iron and folic acid supplementation
H/O whitish discharge not associated with foul smelling
H/O burning micturition
No H/O headache, blurring of vision, vomiting, epigastic pain, decreased urine output
No H/O increased appetite, thirst, increased frequency of micturition
Third trimester
Continue to perceive fetal mmovements
No H/O pain abdomen
No H/O bleeding PV, draining PV
Growth scan done
No H/O suggestive of diabetes, hypertension
Personal history
She consumed mixed diet
Normal bowel and bladder habits
Normal sleep pattern
No H/O drug allergy
Family history
Not a K/C/O DM, HTN, TB, epilepsy, thyroid disorders, cardiovascular disorders
No H/O previous surgeries
No H/O trauma
No H/O repeated blood transfusio
General examination
The patient was comfortable and cooperative, oriented, moderately build, moderately
nourished
Patient was anemic
No icterus
No cyanosis
No clubbing
No genaralised Lymphedenopathy
Bilateral pedal edema confined to the ankle.
Vitals
PR =85 beats /min
BP=130/70 mm Hg
Temperature=
Weight =
Height=
BMI=
No angular stomatitis, glossitis, cheliosis
Nails: no platonychia, no koilonuchia
Thyroid appears to be normal
Spine appear to be normal
Breast appears to be normal.
Abdominal examination
After getting concerned from the patient
After emptying bladder at a supine position, thighs are slightly flexed at hip,
Inspection
Longitudinally distended
Umblicus in midline everted
All quadrants moves equally with respiration
Flank full, hernial orifice free
No scar, cyanosis, dilated veins, visible pulsations.
Palpation
Legs semiflexed correcting the dextro rotation
SFH :
Abdominal girth
Fundal height
After emptying bladder at supine position, legs extended and correcting dextra rotation
Fundal height corresponds to 32 weeks of gestation
Fundal grip
Broad soft, non independently fetal part is present. Suggestion of breech
Umblical grip
Left – multiple small nodular ballatable felt limb buds
Right -smooth curved uniform resistancefelt suggestive of back or spine
First pelvic grip
Hard, round, independently ballatable fetal part felt at lower pole of uterus mobile
propable of head
Second pelvic grip
First Pelvic grip is confirmed
Head is mobile.
Auscultation
Fetal heart sound heard
Sounds are heard at right spino umblical line below the umblicus
140 beats /min, regular in rhythm
Other systemic examination -N
CVS : s1, s2 heard, no murmur,
RS: normal vesicular breath sounds heard. No added sounds
CNS: no focal neurological deficit
Summary
A 20 yrs old primi booked and immunised belonging to low socio economic status with LMP
12/2/21and EDD 19/11/21 c/O of lower abdominal pain with fatigue and headache for the
past one week.
O/E patient was anemic with single live fetus longitudinal lie. Cephalic presentation with
good fetal heart sound not in labour came for institutional evaluation and treatment.
Diagnosis
A 20yrs old primi with 32weeks of gestation with single fetus live longitudinally, cephalic
presentation with good fetal heart sound as diagnosed a care of moderate anemia admitted
for 3weeks not in labour with no other medical and obstretics complication came for
institutional evaluation and treatment.
Investigation
Blood : CBC, blood groping and typing
HB-7% bleeding time and clotting time
Blood : sugar, urea, creatinine
Urine :albumin
Sugar
Pus cells
Urine culture and sensitivity
Peripheral smear
Stool examination
USG
HIV
HBSAG.
VDRL
PREECLAMPSIA
32 yrs old Mrs. Mahalakshmi w/o chellam coming from Tharadapat from TVM, G2P1D1,
belongs to lower middle class,with 7 months of amenorrhea, booked and immunised for Td
vaccine,with regular cycle, LMP( 13/03/2021) ,EDD(20/12/2021) came to OPD with C/O
dizziness and headache for 1month, swelling of leg for 1week
H/O presenting illness:
The patient was apparently normal before 1 month after which she developed dizziness
and headache and swelling of feet for past 1 week
Which is insidious in onset ,does not relieved by rest
No H/O diminished urine output
No H/O diminished fetal movement
H/O headache
No H/O visual defect, giddiness,epigastric pain, vomiting
No H/O pain abdomen
No H/O bleeding pervagina
No H/O draining pervagina
Past history:
Not a known case of DM, HT,TB,Asthma,Epilepsy ,RHD
H/O thyroid disorder for past 1 month
No H/O previous surgeries, bleeding disorder
No H/Oblood transfusion
Menstrual H/O:
She attained menarche at a age of 15 yrs
Irregular cycles , mensturating 5 days changes 4-5 per day
Not associated with clots
Associated with pain
Marital H/O:
Married since 11 yrs
Married at 24 yrs ,non- consanguine
Conceived after 10 years of marriage
Obstetric H/O: G2P1D1
I st trimester :
H/O spontaneous conseption
Pregnancy confirmed by urine pregnancy at 40 days
1st dose of Td was given
H/O nausea and vomiting
No H/O exanthrematous fever
No H/O pain abdomen
No H/O pervaginal bleeding
No H/O drug intake, radiation exposure
Dating scan done at 12 weeks
NT scan done
II nd trimester:
Quickening felt at 5 th month
USG done at 5 th month -anomaly scan
2nd dose of Td was given
No H/O fatigability, breathlessness and palpitation
H/O of IFA tablet
No H/o of blurring of vision,headache,abdominal pain,leg swelling
No H/o of polyuria,polydypsia,polyphagia
No H/O abdominal pain
No H/o bleeding per vagina
III rd Trimester:
Able to perceive foetal movement
H/o of leg swelling,
H/o of headache,
No H/O pain abdomen
No H/o of bleeding per vagina, draining pervagina
USG done at 7th month
Patient was diagnosed to have hypertension,before 2 days and he is on
treatment(labetalol 100mg TDS)
Family H/0:
No H/o of DM,HT,thyroid disorder, epilepsy,asthma in family
No H/O similar disease in family
Personal H/o:
Consumes mixed diet,
General Examination:
Patient conscious, comfortable, co-operative, oriented, moderately built and nourished
Not anaemic
No icterus
No cyanosis
No clubbing
No lymphadenopathy
Bilateral pitting pedal oedema upto knee level
Breast,thyroid,spine -normal
Gait normal
Weight:pre-pregnancy(61kg)
Pregnancy (75kg)
Height:145cm
BMI=38(obese)
Vitals:
Temperature:37.4°C
Pulse rate:62 per minute
Blood pressure:148/98 mm Hg
Spo2:98%
CVS:S1,S2- normal ,no murmur
RS:normal vesicular breath sound heard,no added sounds
CNS: no focal neurological deficit
Abdominal examination:
After verbal consent , after emptying bladder ,patient lie in supine position with semiflexed
leg exposed from xiphisternum to pubic symphysis
Inspection:
Abdomen longitudinally distended
Flanks full
Umblicus flushed to skin and everted
Linea nigra seen
Stria gravidarum seen
No scar ,no sinus , no dilated veins
Palpation:
Legs extended and correcting dextro rotation , empty bladder , fundal height
corresponds to 38 weeks of gestation
SFH:
Abdominal girth:
Fundal grip: Thighs are slightly fixed at hip , broad ,soft ,non independently balloatable
fetal part is present -S/O breech
Umblical grip: Right side – smooth curved , uniform resistance felt,propably spine
Left side- multiple small nodules felt, probably limb buds
First pelvic grip:
Hard ,round, independently balloatable fetal part felt at lower pole of uterus
probably head
Second pelvic group: Head is mobile
Auscultation:
Fetal heart sound is felt at left spinoumblical line
Rate :120 -140/min
Regular in rhythm
Summary:
A 32 yr old Primigravida belonging to lower middle class , booked and immunised with
LMP(13/01/2021),EDD(20/12/2021) with 38 weeks of gestation with consultation of swelling
of feet
O/E bilateral pitting pedal oedema present
Fundal height corresponds to 32 weeks of gestation ,single live fetus , longitudinal lie
with vertex presentation , good fetal heart sound came for institutional evaluation and
treatment
Diagnosis:
A 32 yrs old Primigravida with 28 weeks of gestation has single fetus lying longitunally
,cephalic presentation with good fetal heart sound is diagnosed as a case of Pre eclampsia
with no other medical and obstetrics complication came for institutional evaluation and
treatment
Investigation:
Hemoglobin ,PCV ,
Blood urea, sugar ,serum creatinine
Urine – albumin ,sugar
Urine culture and sensitivity
Blood grouping and typing
BT, CT, OGTT,thyroid function test
HIV,VDRL,HbsAg
Peripheral smear
Specific Renal funtion test
Liver function test
Fundus examination
USG abdomen
GESTATIONAL DIABETES MELLITUS

Name: devi
Age: 33
Occupation: house wife
Educational status: tenth grade
Husband name: gubendran
Age:43
Occupation: theatre owner
Educational status: 5 th grade
According to modified kuppusamy scale socioeconomic status is lower middle class
Obstetric score: G3P2L2
LMP: 10/01/2021
EDD: 17/10/2021
Booked and immunised
Gestational age: 270/7 days= 38 weeks 4 days
Blood group: AB+ ve.
Chief complaints:
Patient was diagnosed as a case of gestational diabetes Mellitus at kalasapakkam PHC
and referred for institutional evaluations and delivery.
H/o presenting illness:
H/o increased blood sugar levels detected by OGTT at 28 weeks of gestation
H/o increased thirst
H/o frequent micturition
No H/o increased food intake
No H/O of UTI at 3 rd month which lasted for 2 months
No H/o bleeding pv
No H/O draining pv
H/o vaginal discharge
No H/O Skin infection
Past history:
She is known case of asthmatic
Not a k/c/O, DM, HTN, TB, epilepsyand thyroid disorders
No H/O recent surgeries
No H/O infections / malignancy in the past
Menstrual H/O
She attained menarche at 14 years regular cycles of 22-25 days with 3-5 days flow and
changes 2-3 pads per day
Not associated with dysmenorrhea
No H/O passage of cloths
Marital H/O
Married since 17 years Consanguinous marriage
3rd degree
Obstetric H/o( G3P2L2)
1st pregnancy
4 years after marriage delivered by normal vaginal delivery , delivered at CMC vellore
No H/O GDM
Female child of birth weight -2. 5 kg
Cried immediately after birth
Breast feeding within 4 hrs and continued for 1year
2nd pregnancy:
6 yrs after marriage delivered by normal vaginal delivery
Delivered at GTVMCH
No H/O GDM
Female child of birth weight -2. 7kg
Cried immediately after birth
Breast feeding within 5hrs and continued for 1year
H/O present pregnancy:
First trimester;
Spontaneous conception diagnosed by urine pregnancy test by herself at 10 th day after
missed periods.
Booked & immunised
Confirmed by dating scan done at 9 th week
Folic acid tablets were taken
H/o burning micturition
H/o increased volume of micturition
No H/ o excessive vomiting
No H/o bleeding pv& draining pv
No H/o abdominal pain
No H/o fever with rashes.
No H/o drug intake
No H/o radiation exposure
Second trimester
Quickening felt at 5th month
2 doses of tetanus toxoid taken at 3rd and 4th month
Iron and folic acid and calcium tablets taken regularly
Anamoly scan was done at 5th month and report was normal
H/O increased thirst,increased frequency of micturition
No H/O headache, blurring vision, epigastric pain, vomiting, pedal edema
No H/ O easy fatigability, breathlessness
No H/O bleeding pv & draining pv
Third trimester
Continued to perceive fetal movements well
Growth scan was done at 7th month and report was normal
Iron and folic acid were taken
No H/O headache, BOV, epigastric pain, vomiting,Decreased urine output
No H/o abdominal pain
No H/O bleeding pv and draining pv
H/O increased thirst, increased frequency of micturition
Patient came monthly once upto 7 months for AN check up
Then after that 2 weeks once
Contraceptive H/O
No H/O of contraceptive use
Family history:
Her father is a known diabetic
NoH/ O children with congenital malformation
No H/O twinning in the family
No H/O HTN, TB, asthma, in other family members
Personal history:
Patient consumes mixed diet
Normal appetite
Normal bowel habits
General examination:
Patient is comfortable , cooperative, moderately build and moderately nourished
Patient is not anaemic, no icterus, no cyanosis, no clubbing, no lymphadenopathy
No Bilateral pitting pedal edema present
Breast examination, thyroid examination, spine examination are normal
Normal gait
Height: 165cm
Weight:
Pre – pregnancy _ 79 kg
Present weight_ 86 kg
BMI- 29.01
Other system examination:
CVS: S1 and S2 heard,No murmurs
RS:
Normal vesicular breath sounds heard
No added sounds
CNS:
No focal neurological deficit
After emptying the bladder and after getting consent exposed from xyphi sternum to pubic
symphysis
Inspection:
Abdomen uniformly distended- flanks full
Corresponding quadrants move equally with respiration- linea nigra, stria gravidarum
present
Umblicus is midline and everted
No visible scars, sinuses, dilated vein is seen
Palpation:
After correcting dextro rotation
No local rise in temperature
No tenderness
Fundal height corresponds to 38 weeks of gestation and flanks full
SFH:
Abdominal girth:
Leopold's manoeuver:
Fundal grip: broad, soft, non independently ballotable. Fetal part is felt suggesting breech
Umblical grip:
On the left smooth curved uniform resistance felt suggesting spine
On the right multiple small nodules felt suggesting limb buds
First pelvic grip:
Hard round independently ballotable mass felt suggesting head at the lower pole uterus
Second pelvic grip:
Converging of hands – so head not engaged
Auscultation:
Fetal heart sounds heard in the left spino umblical line which is 142 beats / minute
Rhythm – regular
Summary:
A 33 yr old G3P2 L2 belonging to lower middle class, booked and immunised withLMP-
10/01/2021and EDD- 17/10/2021 referred from PHC with raised sugar levels, increased
thirst, frequent micturition. On examination, a single live fetus, longitudinal lie, cephalic
presentation with good fetal heart sounds with no other medical and other complications
came for institutional evaluation and treatment
Diagnosis:
33yr old gravida 3 with 2 previous term normal vaginal delivery now with 38 weeks 4days
gestation with single live fetus in cephalic presentation, longitudinal lie, good FHS with
gestational diabetes Mellitus . Good glycemic control complicating pregnancy with no other
medical and obstetric complications for institutional evaluation and delivery
Investigation:
Routine:
Hb, pcv
Blood grouping, typing
Bleeding time, clotting time
Blood: sugar, urea, creatinine
VDRL
HIV
HbsAg
GTT -screening test
Serum TSH
Pap smear
RFT
Specific :
Urine culture sensitivity
Blood sugar monitoring
Urine -ketone bodies
Thyroid profile
HbA1C
USG
Fundoscopy
Management:
Aim:
To maintain 2hrs PPPG in the range of 110-120mg /dl
Meal plan(medical nutrition therapy)
Splitting the usual breakfast into 2equal half and consuming the portion with a two hour
gap in between
Principles:
Avoid sugar, sweets, tubers, fruit juices
Avoid fasting
Eat to satisfy appetite
Eat more green leaf vegetables
PPPG is less than 120mg /dl under control by meal plan
Continue the meal, repeat 2hrs PPPG once every 4 weeks
Principles of management:
Control of DM
Obstetric management
Timing of delivery
Specialized core
Insulin schedule:
Blood sugar if not controlled initiate insulin therapy
If 2hrs PPPG is greater than 120mg/dl Advice intermediate acting insulin eg. Insulaterd or
premised insulin 30/70 four units, 30mins before breakfast
Repeat 2hrs PPPG after 2weeks ,within 120mg/dl continue the same dose
If values are high increase the dose by 2-4 units i. e 6-8units , 30 mins before breakfast
Repeat the test every 15 days, titrate the dose to achieve the 2hrs PPPG between
110-120mg/dl
BREECH PRESENTATION
A 21 year old Mrs. Malathi(w/o Mr. Karthikayen) housewife from Thiruvannamalai,
belonging to lower socio-economic status G2P1L1, booked and immunised against Td,
regular cycles, LMP 1/1/2021 EDD 8/10/2021 with 9 months of amenorrhoea came for
institutional treatment and delivery.
H/o of Presenting Illness.
Perception of fetal movements
No h/o bleeding pv draining pv
No h/o abdominal pain
No h/o headache, blurring of vision, epigastric pain, vomitting and decreased urine output
Menstrual History.
Attained menarche at 14 years of age
Regular cycles 5/28 day, normal flow changes 3-4 pads per day, not associated
with pain /clots.
Marietal History.
Married since 4 years
Non-consanguinous marriage
Obstetric History.
G2P1L1
⮚ 1st Trimester.
H/o spontaneous conception
Pregnancy was confirmed by UPT 4weeks.
Folic acid tablets were taken
No H/o pain abdomen
H/o nausea, vomitting
No H/o exanthematous fever with rashes
No H/o drug intake
No H/o radiation exposure
No H/o pv bleeding
No H/o burning micturition
Dating scan done, NT scan done
⮚ 2nd Trimester.
Anomaly scan done and was normal
Iron, Folic acid, and calcium tablets were taken
No H/o fever with rashes
No H/o radiation exposure or drug intake
No H/o increase thirst, increase frequency of micturition, increase
appetite
No H/o headache, blurring of vision, epigastric pain, reduced urine
output and vomitting
No H/o easy fatiguability, palpitation and breathlessness
No H/o polyuria /polydypsia
No H/o pv bleeding
No H/o increase BP and other Ix are normal
No H/o burning micturition
⮚ 3rd Trimester.
Perception of fetal movements
No H/o pv bleeding
Iron and calcium tablets taken
Growth scan done
Weight gain in pregnancy
Past obstetric History.
Conceived 2 months after marriage with H/o malpresentation,

delivered through LSCS at GTVMMCH,female baby 2.5 kg at birth, cried
immediately, no postpartum complication and exclusively breastfeed for 6
months.
Past History.
No H/o Diabetes mellitus, Hypertension,Tuberculosis, Epilepsy, Asthma.

No H/o blood transfusions
No H/o surgery in past
No H /o trauma
Personal History.
Consumes mixed die

Bowel and bladder habits normal
Family history
No H/o Diabetes, HTN, TB, Epilepsy, Asthma, rheumatoid heart disease
No relevant family history
No H/o congenital anomalies
No H/o twins in the family
General Examination
Patient was conscious, oriented to time and place, comfortable and
cooperative, moderately built and nourished
No anemia, icterus, clubbing, cyanosis, lymphadenopathy
H/o bilateral mild pitting pedal edema
Breast, thyroid, spine examination normal
Gait : zordotic gait
Height :162 cms
Weight:60 kg
BMI : 20.9
Vitals
BP:110/70
PP:88/min
RR:16/min
Temperature :98.4°F
Other system
Cvs:s1 s2 heard, no added murmurs
RS: normal vesicular breath sound, no added sound
CNS:no focal neurological deficit
Obstetric Examination:After getting consent from the patient,emptying the

bladder, exposing from xiphisternum to public symphysis.
⮚ Inspection:
Patient on supine consent(verbal consent)
Abdomen longitudinally distended, flanks full
Umbilicus flushed to the surface
Stria gravid arum, line a niagra seen
A Suprapubic transverse scar 15 cm healthy scar
No presence of sinus, dilated veins
⮚ Palpation: (after emptying the bladder)
1. Fundal height
Fundal height corresponds to 39 weeks of gestation, flanks full
Symphysiofundal height 36 cm
2. Fundal grip:
Hard, round, independently ballotable fetal part – probably head
3. Umbilical grip
Smooth, curved, hard, uniform resistance denotes back on left side
4. I) 1st pelvic grip:
Reveal broad, soft, non independently ballotable fetal part
indication breech in lower pole
II) 2nd pelvic grip:
Breech is not engaged
⮚ Auscultation :
Fetal heart sound is heard above the umbilicus on the left side
Summary
A 21 year old G2P1L1, booked and immunised with 9 months of
amenorrhoea corresponding to 39 weeks of gestational age with previous Obstetric History
of baby delivered through LSCS due to malpresentation. On examination, a single like fetus,
longitudinal lie, Breech presentation, fetal heard sounds are well perceived with no other
complaints without medial and obstetric complications and not in labour.
Diagnosis
A 21 year old second gravida para one live one who has completed 39 weeks of
gestation with previous LSCS due to breech presentation with single live fetus, with good
fetal heart rate who has been admitted for institutional deliver Management
⮚ Confirm the diagnosis by USG
⮚ Delivery plan:
Elective LSCS > 38 weeks at GTVMMCH along with sterilisation
⮚ Baseline investigation :
Hb, PCV, urine albumin, blood grouping, typing, BT, CT, blood sugar
RFT:blood urea, creatinine
LFT
TFT
HIV, VDRL, HbsAg, HCV
Specific USG
TWIN
Rameeja Bhanu, 35 year old, G4P2L2A1, housewife from Thandarampit, W/O Ahmed Basha,
belonging to Lower Midldle class, with 8 months of amenorrhoea,LMP-05/03/2021 and
EDD-12/12/2021, B&I came to the OPD with the chief complaints of Lower abdominal pain
for the past 2 days.
HOPI:
The patient was apparently normal before 2 days after which she developed lower
abdominal pain which was sudden in onset, non-progressive, non-radiating, relieved by rest.
No history of bleeding PV.
No history of draining PV.
Able to perceive fetal movements well.
No history of imminent signs suggestive of preeclampsia like headache, blurring of vision.
History of fatigability, breathlessness.
MENSTRUAL HISTORY:
Attained menarche at 14 years
Regular cycles;5/28 day cycle
Changes 3 pads per day.N/A with clots.
MARITAL HISTORY:
Married at 20 years;since 13 years.
Non-Consanguinious marriage.
No history of contraceptive used.
OBSTETRIC HISTORY:
Present Obstetric History: LCB-11 years back
I st Trimester: Confirmed pregnancy by UPT
Spontaneous Conception
Booked and Immunized.
History of nausea and excessive vomiting
History of consumption of Folic acid supplements
Dating scan done
No history of fever with rashes
No history of burning micturition
No history of radiation exposure
No history of bleeding PV, draining PV, Lower abdominal pain
No history of any other drug intake.
Routine investigations done and found to be normal.
2 nd Trimester:
Quickening felt at 4 months.
Anomaly scan done
IFA tablets taken
No history of polyphagia, polyuria,polydipsia
No history of headache, blurring of vision, nausea and epigastric pain
History of easy fatigability. Hb concentration was found to be low and parenteral iron
given.
No history of bleeding PV, draining PV,pain abdomen
3 rd Trimester:
Continued to perceive fetal movements
History of lower abdominal pain
History of bleeding PV
No history suggestive of GDM, PIH
Growth scan taken.
Hb estimation done and found to be anemic.
Past Obstetric History:
1st Pregnancy:
Conceived after 3 years of marriage. Underwent treatment for infertility. Spontaneous
full term NVD at Institution.
Outcome: Boy weighed 3 Kg 100gm
Cried immediately after birth. Breastfed after 2 hrs
Immunized
No NICU admission
PP period uneventful.
The boy is 10 years old.
2nd Pregnancy:
Conceived 2 years after 1st child
Spontaneous conception
Spontaneous full term NVD at Institution
Outcome: Girl weighed 3 Kg; Cried immediately after birth; Breastfed within half an
hour; PP period uneventful
No NICU Admission
The girl is 8 years old.
3rd Pregnancy:
Conceived 8 years back
History of spontaneous isolate miscarriage at 2nd month
No history of trauma
History of hospitalization and evacuation.
Past History:
No history of previous surgery
No history of trauma
No history of blood transfusions
N/C/K/O DM, Asthma, Tb, CAD
Family History:
No history of DM, HTN, bleeding disease in families
No history of twins in the family
No H/o congenital anomalies
No H/o bleeding disorder
Personal History:
Consumes mixed diet
Normal bowel and bladder
Examination:
Patient is cooperative, comfortable, moderately built and well nourished.
General Examination:
Patient is anemic
Not icteric
No cyanosis
No clubbing
No pitting edema
Gait, Thyroid, Spine, Breast normal
Arthropometry:
Weight-83kg
Height-150cm
BMI-36.8
Other systems Examination:
Local Examination:
Inspection:
Barrel shaped, over distended abdomen.
Umbilicus in midline, flushed with skin.
Flanks full
Linea nigra seen
Stria albicans gravidorum seen
No scars, sinuses and dilated veins seen
Palpation: Obtaining consent
After emptying bladder with adequate privacy, after correcting dextrorotation,
Fundal height corresponds to 36 weeks of gestation
Fundal grip –with legs semiflexed
Multiple fetal parts felt.
3 fetal poles felt
Hard round independently ballotable mass felt at right side suggestive of
fetal head
Umbilical grip- Hard round independently ballotable mass felt probably head.
1st pelvic grip- Broad, round, soft, not independently ballotable
2nd pelvic grip- Hands are diverging- unengaged
Auscultation:
2 distinct fetal heart sound heard; 10 cm apart.
Right-Spinoumbilical line
Left-Side at the level of umbilicus
Summary:
Elderly Gravida(35 Years), G4P2L2A1, regular cycles with 2 previous NVD at term and one
spontaneous isolated incomplete abortion, 8 months of amenorrhoea and came with
complaints of lower abdominal pain for past 2 days. On examination, pallor present,
overdistended abdomen, fundal height 36 weeks of gestation, multiple fetal parts felt, 2
fetus 1st twin in breech presentation with anemia complicating pregnancy with no other
medical and obstetric complications came for Institutional evaluation and treatment
Dx: Elderly Gravida G4P2L2A1 regular cycles with previous NVD at term and 1 spontaneous
isolated abortion now with 36 weeks of gestation 2 live fetuses longitudinal lie; Obe breech
and one transverse presenation good FHR with multiple pregnancy complication with
polyhydromnios. No other medical or obstetric comorbidities came for institutional
evaluation.
Ix:
Basic:
1. Hb concentration; blood grouping and typing
2. Urine- albumin and sugar deposits
3. VDRL, HBSAg, HIV screen
4. OGTT
5. TFT
6. BT, CT
Specific:
1.USG
2.NT
PREVIOUS LSCS
Mrs.parameshwari 25 years old , housewife from thiruvannamalai came to OPD with her
husband balakrishna, she belongs to upper middle class of social economic status.
G2P1L1
Booked and immunized
LMP- 13/01/2021
EDD- 20/10/2021
Chief compliants:
H/O of 9 months of amenorrhoea presented with 39 weeks of gestation, a case of post
c-section referred from PHC for institutional evalution and management.
HOPI:
NO History of pain abdomen
No H/O bleeding PV
No H/O draining PV
Able to perceive fetal movements.
No immient symptoms suggestive of GHT like headache, blurring of vision, epigastic pain,
vomiting, decreased urine output.
Past history:
Not a k/c/o – DM, TB, Asthma, HTN, epilepsy
No H/O recent surgery
No H/o trauma
Menstrual history:
Age of attainment of menarche -14 yrs
Regular cycle of 20-30 days
Normal flow for 4-5 days
Changes 2-3 pads / day
Not associated with pain or passage of clots
History of copper T insertion following previous pregnancy
Obstetric history:
Past obstetric history:
Same all detailed history to be presented
H/O of present pregnancy:
Booked and immunized G2P1L1- 1st pregnancy.
LMP- 13/01/2021
EDD- 20/10/2021
1st TM
H/O of spontaneous conception
Pregnancy was confirmed after 2 months of missed cycle by urine pregnancy test.
Dating scan was done and found to be normal and corresponding with dates.
Folic acid tablet were taken
No H/O pain abdomen
No H/O bleeding PV
No H/O draining PV
No H/O of fever and rashes / vomiting
No H/O of burning micturition
No H/O drug intake / radiation exposure
Regular AN check up.was done and no abnormalities found in 1st TM.
2nd TM
Anomaly scan was done and found to be normal
2nd dose of TT was taken
Iron, folic acid and calicum are taken
No H/O pain abdomen
No H/O bleeding PV
No H/O draining PV
No H/O headache, blurring of vision, epigastic pain,decresed urinary out put and vominting
No H/O of increased appetite or thrist
No H/O of easy fatiguability
Regular AN check up.was done and no abnormalities found in 2nd TM.
3rd TM
Continued to percieve fetal movements
Iron, folic acid tablet were taken
Gowth scan was done and found to be normal
No H/O pain abdomen
No H/O bleeding PV
No H/O draining PV
No H/O headache, blurring of vision, epigastic pain,decresed urinary out put and vominting
No H/O of increased appetite or thrist
Past obstetrics history
Antenatal events- Booked and immunized at govt hospital
Perinatal events- post term baby, institutional delivery by elective LSCS 3 YRS back on
16/6/18 at 41 weeks of gestation
It was done 7days after EDD
Indication-prolonged pregnancy with failure of induction
Outcome- alive boy baby ,of 3.1 kgs birth/ wts and well immunised.
No H/o NICU admission
Currently healthy and cried immediately after birth and doing well
No fever/ wound discharge in postoperative period
No blood transfusion
Sutures were removed on 11th day
Postnatal events-uneventful
Personal history- consumes mixed diet
Normal sleep pattern/ sleep cycles
No bowel and bladder movement
NoH/O of any addiction
EXAMINATION
GENERAL
Patient comfortable and co operative , moderatly build and afebrile
Not anemic,not icterus, no clubbing,no cyanosis,bilateral pitting pedal edema, no
lymphadenopathy.
Breast, thyroid, spin-normal
Gait- lordotic gait
Vitals
Pulse rate-88per min
BP- 110/80mmHg
Respiratory rate-23/min
Height -160cm
wts-pre pregnant-52kgs Pregnant – 63 kgs
BMI-24.6( NORMAL)
SYSTEMIC
CVS – s1 and s2 heard. no murmur heard
RS- Normal vesicular breath sound/ no added sound
Abdominal
After explaining the procedure and getting concern, following which examination to be done
after emptying the bladder and exposing from xiphisternum to midthigh.
Inspection
Abdomen longitudinally distended flanks not full
Umblicus is center and flushed to the skin.
Linea nigra and stria gravidum present.
Previous LSCS scar present.
Horizontal scar of 10cm noted 3cm above the pubic symphysis.
Healed by primary inteution,without hypertrophy and keloid formation
No sinus /dilated veins /scar
Hernial orifice is intact
Palpation
No local rise in temperature and tenderness
Fundal height corresponds to the gestational age 32 Weeks with flank -full
SFH:
Abdominal girth:
Fundal grip
Broad,soft ,bulky non independently bullotable – s/o breech.
Umblical grip
Right lateral grip- smooth curved .hard uniform resistance
Left lateral grip-multiple small nodules felt s/o
First pelvic grip
Hard found independently ballotable mass- s/o fetal head
Second pelvic grip
Finding of first pelvic grip is confimed
Fingers convergers-head not engaged
No scar tenderness
Auscultation
FHS heard along it spino umblical line -146 beats /min
Summary
A 25 yrs old LMP 13/01/21 EDD 20/10/21 G2P1L1 a booked and immunised case with
previous first post term elective LSCS for non recurrent indication.
On examination , bilateral pitting pedal edema,a healthy horizontal scar of 10cm noted 3cm
above the pubic symphysis,fundal head correnponding to 32 weeks flank full,a single life
fetus longitudinally lie cephalic presentation with good fetal heart sound not in labour came
for institutional evaluation and management.
Diagnosis
A 25 yrs old G2L1P1A0 with 34 weeks of gestation , with previous LSCS ,having single life
fetus longitudinally lie cephalic presentation with good FHS and with no other obstretics and
comorbidities cause for institutional management and delivery.
Investigation
Routine investigation: Hb,BG,rh typing ,blood urea sugar,HIV,VDRL ,HBSAG,Usg.
Management : There is no other obstretics and medical comorbidities and also the scar is
healthy.so I wanna go for VBAC.
POST DATED DELIVERY

A 18 year old primigravida coming from kalasapakkam w/o Shankar,26 year old,who is a
construction worker belonging to lower socioeconomic status according to MKS.She is a
primigravida.Her
LMP-27/12/2020
EDD-3/10/2021
Gestational age-40 weeks and 5days
Came with chief complaints of amenorrhea with pain abdomen from yesterday morning
4AM
HOPI: She is booked and immunized in nearby PHC.

She complains of pain abdomen from yesterday, originates from the back and radiate to
the lower abdomen and then to the thigh, which was gradual in onset and progressive in
nature.
No history of bleeding PV
Fetal movements are well perceived by her.
Past history
Not a known case of DM, HTN, Tb, Bronchial Asthama, Epilepsy, Rheumatic heart disease,
Thyroid dis: orders.
No history of drug intake other than IFA No history of previous surgeries No history
of blood transfusions
Menstrual history:
LMP-27/12/2020
Age of menarche at 13 years, regular cycles of 30 days, flow for 3 days, changes 2 pads
per day, not associated with pain or passage of clots
Marital history:
Married since 1 year, conceived within 1 and half months of her marriage, non –
consangiuneous marriage
Obstetric History:
She is booked and immunized at PHC 1stTrimester:
History of spontaneous conception, pregnancy detected by UPT after 1 and half months
of her missed period in PHC.
1st dose of Tt is given
Folic acid tablets were taken regularly

No history of excessive vomiting
No history of fever with rashes
No history of drug intake or radiation exposure
1st trimester scan was done and the pregnancy was confirmed
No history of pain abdomen, bleeding or leaking PV
2nd Trimester:
Quickening felt at 5th month and continued to perceive fetal movements well and taken
regular ANC visits
Anomaly scan was done at 6th month and she said it was found to be normal
2nd dose of Tt given 4 weeks apart
Iron Folic acid and calcium were taken regularly;History of easy fatigability
No history of pain abdomen, bleeding or leaking PV
No history of increased volume of micturition, increased thirst, increased appetite
No history of headache, blurring of vision, epigastric pain, vomitting, decreased urine
output
No history of dyspnea, palpitations
Underwent routine lab tests and found to be that her Hb was low. So, parenteral
administration of iron is given at seventh month on alternate days, 4 doses given
3rd trimester:
Fetal movements are well perceived

IFA and calcium tablets taken regularly
Third trimester scan done and was found to be normal
History of frequent micturition
No history of S/O raised blood pressure, anemia
No history of abdominal pain, bleeding or leaking PV
Underwent routine lab tests and now Hb was improved
Personal History:
Consumes mixed diet, Normal Appetite
Normal sleep pattern, adequate sleep during night and two hours in afternoon
Family History:
No history of post dated or prolonged pregnancy in the maternal side of her family
No history of DM, HTN, Tb, Epilepsy, Bronchial Asthma, RHD,Thyroid disorders.
No history of twining in the family
No history of congenital anomalies in the family.
General Physical Examination:
She is conscious, comfortably placed, well oriented, cooperative, moderately built and
nourished.
No pallor, No Icterus,Cyanosis, Clubbing, Generalized lymphadenopathy, pedal edema.
Height-145cm
Pre-pregnant weight-48kg
Present weight-54kg
BMI-22.85kg/m2
Breast, Thyroid, Spine normal Vitals:
Temperature-98.6°F
Pulse Rate-90 beats per minute, regular in rhythm, normal volume and character, No R-R,
R-F delay, All peripheral pulses are felt bilateral
Blood Pressure-120/70mm Hg, right arm, sitting position
Respiratory Rate-17 cycles per minute Systemic Examination:
Respiratory System:
No altered sounds
Cardiovascular System:
S1, S2 heard
No murmurs
Central Nervous System:
Abdominal Examination: After getting consent,
She is exposed from xiphisternum to pubic symphysis in a lightened room
INSPECTION:
Abdomen is uniformly distended and flanks are full
Umbilicus is placed centrally and exerted
Linea nigra, Striae gravidarum present
No scars, sinuses, dilated veins
Hernial orifices intact
PALPATION:
No local rise in temperature or tenderness
After correcting dextrorotation, fundal height corresponds to term 32 weeks of gestation
Symphysis fundal height 32cm
Abdominal girth 80cm Leopold’s Manovure:
1.Fundal grip-soft, broad mass felt suggestive of breech
2.Umbilical grip
Right side-uniform continues curved resistance feltsuggestive of spine
Left side-Irregular knob like structures-suggestive of limb buds
First pelvic Grip- Hard, not ballotable mass felt-suggestive of fetal head
Second pelvic grip-fingers are diverging-sugesstive of that head is engaged.
AUSCULTATION:
FHS are heard, 142 bpm, regular rhythm
SUMMARY:
A 18 year old Primi Gravida, Booked and Immunized came with 9 months of amenorrhea
corresponding to 40 weeks plus 5 days of gestation crossing her EDD, regular cycles came
with pain abdomen with well perceived fetal movements. She is anemic during 2nd trimester
and was treated by giving parental iron. On examination, single live fetus with fundal height
corresponding to 32 weeks of gestation flanks full, longitudinal lie, Cephalic presentation
and engaged head with good FHS without any medical and Post dated complications not in
labour came for Institutional delivery.
Diagnosis:
A 18 year old Primi Gravida with 40 weeks plus 5 days of gestation with post dated
pregnancy crossed EDD by 5 days having single live fetus, longitudinal lie, cephalic
presentation, engaged head, with good FHS, without medical or obstetric complications not
in labour came for Institutional delivery.
Investigation:
1.Monitor mother
Hb, BP, Pulse, SpO2, warning signs, symptoms,access
BISHOP score, USG
2.Monitor Baby
CTG, Modified Biophysical Profile,NST
3.Planning for vaginal delivery by induction of laboring
GTMMCH. After routine investigations of Hb concentration, PCV, Blood grouping and typing,
HIV, HBsAg, VDRL, urine routine, Blood sugar.
4.Foley’s is used for induction.
PGE2 Gel or Misoprostol- BISHOP<6

5.If BISHOP score >6
• Go for ARM only when she is in active labour

• Oxytocin I.v. infusion given.
6.USG-BPD,FC,AC,HC, Wt, Liquor, Placenta
7.DOPPLER-Umbilical abnormal, MCA, Ductus venous.
8.BISHOP
• <6-not favourable
• >6-favourable
CEPHALO PELVIC DISPROPORTION

Name :Mrs.xyz
Age:22yrs
Address:Kilpauk
Occupation: Homemaker
SES:Class 3 [Mod.kupp.scale]
Primigravida
Booked &Immunised at KMC
LMP-07/03/2020
EDD-14/12/2020
Gestational Age -38 weeks +5days
She is primigravida with 9months of amenorrhea with 38weeks of gestation for regular AN
checkup.
No h/o pain abdomen
No h/o bleeding or draining PV
Fetal movements are perceived well
Obstetric H/O:
H/O present pregnancy:
1st trimester:
• Spontaneous conception after 1 yr of marriage .

• UPT was done at 5 weeks of amenorrhea and the pregnancy was confirmed by ultrasound.
• Dating scan done at 8 weeks .
• NT scan done at 12 weeks and found to be
normal .
• H/O morning sickness present .

• Folic acid tablets were taken .
• No H/O fever with rashes.
• No H/O drug intake or radiation exposure.
• No H/O pain abdomen ,bleeding or leaking PV.
• No H/O burning micturition.
• No H/O hyperemesis gravidarum.
2nd trimester:
• Quickening felt at 20 weeks.

• Anomaly scan done at 18 weeks and found to be normal.
• Iron and folic acid ,calcium were taken regularly.
• Immunised with 2 doses of TD 4 weeks apart.
• BP &OGCT were found to be normal.
• No H/O pain abdomen ,bleeding or leaking PV.
• No H/O easy fatiguability ,dyspnea,palpitations.
• No H/O headache,blurring of vision,epigastric pain,decreased urinary output,vomiting
• No H/O increased appetite, increased volume of micturition ,increased thirst.
3rd trimester:
• Fetal movements are well perceived.
• Growth scan was done and found to be normal.

• No H/O pain abdomen, bleeding or leaking PV.
• No H/O S/O PIH,GDM,anemia.
RISK-CORD PROLAPSE
Menstrual history:
• Age at menarche-14yrs
• Regular cycles 28days with 4days of flow,changes 3pads/day,not associated with pain and
clots.
• LMP-7/3/2020
Marital H/O:
• Married since 1yr ,non consanguinous marriage.

Past H/O:
• No H/O DM,HTN,thyroiddisorder,bronchial
asthma,CVD,epilepsy,rickets,osteomalacia,tuberculosis of hip, Pelvic joints or spine
• No H/O fracture or surgery of pelvis or spine.
• No H/O fracture or surgery of lower limb.
• No H/O tumours of hip or lower limb.
• No H/O of polio in childhood.
Personal H/O:
• Consumes mixed diet & N appetite

• Normal bowel & bladder habits.
• N sleep pattern -8hrs @night ,2hrs in afternoon
• No H/O drug addictions
Family H/O:
• No H/O DM ,HTN,TB in family.

• No H/O bleeding disorders in family.
Summary:
Mrs.xyz,a 22yr old,primigravida with LMP-7.3.2020 &EDD - 14.12.2020 at 38 weeks +5days

of gestation who is booked &immunized belongs to class 3 SES(acc to MKS) has come for
regular ANC checkup with 9months of amenorrhea and no other complaints.her 1st &2nd
trimester were uneventful .
General physical examination:
• Patient is conscious, oriented ,comfortable,cooperative.

• Moderately built &nourished.
• No pallor ,icterus,cyanosis,clubbing,lymphadenopathy,pedal edema.
• No deformities of spine
• Breast appears to be normal.
• Thyroid examination:N
• Gait:waddling gait-walking like duck
• She is short stature.
• No shortening of lowerlimb.
• Wt-48kg
• Ht-139 cm
• BMI-24.8 N
• Present wt-58kg wt gain: 10kg
VITALS:
BP-120/78mmHg,Rt.upperlimb,sitting position
PR-86 beats /min,regular in rhythm, N in volume,character,No R-R ,R-F delay ,all peripheral
pulses are felt on both sides equally.
RR-18/min,thoracoabdominal type
Temp-98.4°F.
Obstetric examination:
• After getting consent from the patient and she was asked to empty her bladder.
• Abdomen was exposed from xiphisternum to pubic symphysis.
• Examined in dorsal position with semiflexedthigh.
Inspection:
• Abdomen is longitudinally distended, flanks- full.

• Umbilicus in midline &exerted.
• All quadrants move equally with respiration.
• Linea nigra,stria gravidarum seen.
• No scar, sinuses,dilated veins.
• Hernias orifices intact.
Palpation:
• Fundal height corresponds to 32 weeks of gestation which corresponds to term

• Symphysio fundal height-
• Abdominal girth-95cm
• After correcting dextrorotation.
Fundal grip - Broad ,soft,bulky not independently ballotable mass probably breech.
Umbilical grip -
Lt side - smooth ,curved ,hard uniform resistance felt -probably spine .
Rt side -multiple small nodules are felt -probably limb buds .
1st Pelvic grip-hand,round,independently ballotable mass -probably head
2nd Pelvic grip- findings of 1st Pelvic grip confirmed ,hands converging ,not engaged
Abdominal method-head flushed the pubic symphysis.
NO CPD
Mild CPD-flushed
Major CPD -overriding of head with PS
Abdominopelvic assessment of CPD and PV examination to be done.
Auscultation:
• Fetal heart sounds heard at left spinoumbilical line below umbilicus.

• Fetal heart rate 140beats /min.Regular in rate &rhythm.
Systemic examination:
• RS: Normal vehicular breath sounds heard .

No added sounds .
• CVS: S1,S2 heard .no nurmurs.

• CNS: No focal neurological deficit.
Summary :
A 23 yr old primi,Mrs. Xyz booked &immunized belongs to class 3 (mks) has come at 32
weeks of gestation with LMP-7.3.2020 and EDD-14. 12.2020 for regular AN checkup with no
significant complaints. She was of short stature &her ht is 139cm. On Obstetric examination
she has single
live fetus ,longitudinal lie,cephalic presentation ,head is mobile . On abdominal method

head flushes the pubic symphysis and Fetal heart rate -140/min.
Diagnosis:
A 23 yr old primi gravida with 32 weeks of gestation with short stature with single live fetus,
longitudinal lie, cephalic presentation with good fetal heart sounds with no other medical
and obstetrics complications came for institutional evaluation and treatment.
HEART DISEASE IN PREGNANCY
Mrs .XYZ of age 24 yrs from Bangalore, homemaker , completed her education upto class 10
who is a wife of Mr. XYZ , 27 yrs old auto driver belongs to low socioeconomic class is
primigravida , booked and immunized at
LMP : 07.07.2020
EDD : 14.04.2021
Came with chief complaints of 2 months of amenorrhea. She has reported for her first ANC
visit and is currently asymptomatic who is a known rheumatic heart disease patient.
History of presenting illness
No H/O of breathlessness
No H/O cough with expectoration
No H/ O of haemoptysis
No H/O of fever
No H/O of swelling of legs
No H/O of chest pain
No H/O of orthopnea
No H/O of PND
No H/ Of syncope
No H/ O diminished urine output
No H/O of any hypertensive dls
Obstetric history
She is a booked and immunized case at PHC .
Pregnancy detected by UPT after ½ month of her missed periods in PHC
H/O spontaneous conception
No H/O excessive vomiting
No H/ O drug intake or radiation exposure
No H/O pain abdomen , bleeding , or leaking PV
No H/O chest pain , breathlessness, syncope , fatigue , palpitations, orthopnea,PND , pedal
edema
Menstrual history
Age of Menarche- 13 yrs
Regular cycles of 28-30 days
3-4 days of flow
Changes 2-3 pads/ day
Not associated with pain
No passage of clots
Marital history
Married since 1 yr
Non consanguinous marriage
No H/O contraception
Past history
At 12 yrs of age ,she was admitted for fever with severe joint pains . Rheumatic heart disease
treated with antibiotics at a local hospital. She has been on 2° prophylaxis of Inj Benzathiane
penicillin in every 3 weeks
No H/O DM,HTN,TB,epilepsy ,asthma thyrotoxicosis,recurrent respiratoryinfections,CCF
No H/O surgeries in the past
No H/O blood transfusions
No H/O drug allergy
Personal history
She consumes mixed diet
Normal appetite
Normal bladder and bowel habits
No H/O of drug addiction
Family history
NO H/O DM,HTN, asthma, TB,heart disease in the family
No H/O of child with congenital malformation
No H/O twining in the family
Summary
A 20yr old primigravida who is booked and immunized with LMP- 7.07.2020 and
EDD-14.04.2021 with the 2 months of amenorrhea with 10weeks +three days of gestation
spontaneous conception with past history of Acute Rheumatic fever ,currently on monthly
Benzathiane penicillin secondary prophylaxis presented for routine ANC visit and is currently
asymptomatic
General examination
Patient is conscious, oriented,cooperative,and moderately built and nourished
Mild pallor, noicterus,cynosis,clubbing,generalized lymphadenopathy,pedal edema
JVP not raised
Ht- 155cm
Wt-58kg(prepregnancy)
BMI-24.14Kg/m2
Vitals
Temp-afebrile
PR- 90 beats/min
BP-110/70mmhg
RR- 16 breaths/min
JVP not raised
Breast,spine,thyroid normal
Gait normal
Systemic examination
CNS- no focal neurological deficit
RS- bilateral equal air entry, vesicular breath sounds in all areas of lung, no added sounds
CVS-S1 loud
Systolic murmur grade 2, abnormal diastolic murmur
Inspection
Trachea appears to be in midline
No chest wall deformity,
no scars, sinuses,dilated vein
Visible apical impulse medial to mid clavicular line
No pericardial bulge
Palpation
Trachea confirmed to be in midline
Apical impulse at 5th intercoastal space ½ inch medial to mid clavicular line,tapping in
nature
No parasternal heave,thrills palpated
Percussion
Dullness on apex
S1 loud
S2 loud
Auscultation
S1,S2 audible S1 louder than S2 , P2 is loud
Mild diastolic murmur in mitral area,grade 2, increased on expiration and decreased on
inspiration, presystolic accntutuation present.
Opening snap present
No abnormal sounds heard in any other region
Inspection
Lower abdomen slightly distended
Umbilicus in midline,inverted
No linea nigra,stria gravidarum present
No scars, sinuses,dilated veins seen
Hernial orifices are intact
Palpation
Soft, non tender
No palpable mass or hepatosplenomegaly
Percussion
No fluid thrill
Auscultation
Normal bowel sounds heard
No bruits heard
Summary
A 24 yr old primigravida who is booked and immunized with LMP 7/7/2020,EDD14/4/2021
with 2 months of amenorrhea with 10weeks +three days of gestation spontaneous
conception with past history of Acute Rheumatic fever currently on monthly Benzathiane
penicillin secondary prophylaxis presented for ANC visit and is currently asymptomatic. on
examination mild pallor was seen, mild diastolic murmur with open snap and with
presystolic accentuation was heard . On s/o mitral stenosis,RHD, NYHA-grade 1
Diagnosis
A 24 yr old primigravida at 10weeks +three days of gestation presented for ANC , with
examination findings mitral stenosis of rheumatic origin in sinus rhythm, with no evidence of
infective endocarditis, not in failure NYHA grade 1 complicating the pregnancy with no other
medical and Obstetric complications for safe confinement of pregnancy.
Rh -ve PREGNANCY
Mrs.xyz , 29 year old , housemaid by occupation , address,
Educated till 8th std
Blood group: B-ve
Married for 5years
Husband details
Mr.xyz , 31 year old
Blood group B+ve
Occupation farmer
SES : Low SES
LMP: 28 JULY 2020
EDD: 4 MAY 2021
POG: 10 Weeks ,1 day
G3P1L1A1
She has come with 10weeks of amennorhea for her first AN visit and is currently
asymptomatic
Past history
No major medical problems like HTN , DM , TB , asthma, thyroid disorders, epilepsy, bleeding
problems or drug treatment history
No surgical history
Menstrual history
Age of 13 years
Past cycles – regular, 28-30 days -f/b 3-4 days of menses
Not associated with dysmenorrhoea or passage of clots
Marital history
Married for 5 years
Obstetric history
G3P1L1A1- 10 Weeks 1 day- POG
H/O first pregnancy
● 2016 ( at 25 years of age )
● ANP -unevent full
● Full term normal vaginal delivery
● H/O costly injection administration on 3rd day in the upper arm
● Baby 2.8 kg , cried at birth, live and healthy
Second pregnancy
● 2018( at 27 years of age)
● Spontaneous abortion at 3rd month
● Spontaneous conceptus delivery
● Was managed at village . No H/O prophylactic anti D was given post abortion
History of present pregnancy
Spontaneous conception
First trimester:
Diagnosed by UPT
USG: conformed pregnancy , dating scan done
Routine ANC investigations have been adviced , reports awaited
No H/O excessive nausea and vomiting
No H/O bleeding PV or discharge PV
No H/O pain abdomen
No H/O burning micturation, increased frequency of micturation
No H/O radiation or teratogenic drug exposure
No easy fatigability
Family history
No H/O diabetes, HTN , asthma, TB, epilepsy, dyscarasia , knorn hereditary disease in family
No H/O children with congenital malformations
No H/O twinning
Blood group of siblings
Personal history
Consumes mixed diet
Good appetite
Normal sleep patterns
No H/O alcohol, smoking
No H/O drug allergy
No H/O contraceptive use
General physical examination
The patient is conscious, co operative, well oriented to time , place and person
Patient is moderately built and nourished
Consent was taken and examined in presence of female attendant
Vitals:
Patient is afebrile
PR : 82 beats / minute in right radial artery which is regular in rhythm , good volume ,
normal in character , no vessel wall thickening , equal on both sides , No
RR, RF delay and all the peripheral pulses were palpable
BP : 120/74 mmHg in right arm
RR : 16 breath /min
JVP : not raised
● Mild pallor
● No icterus , cyanosis , clubbing generalised lymphadenopathy and pedal edema
● BMI : 24.14 Kg / m2
● Gait and spine normal
● thyroid normal
● Breast normal
● No dilated veins over the neck
RS : normal vesicular breath sounds heard . No added sounds
CVS : S1,S2 heard , no murmurs
CNS : no focal neurological deficit
Abdominal examination ( If more than 28 weeks POG )
After getting consent and emptying the bladder , she is exposed from xiphisternum to public
symphysis in well lightened room.
Inspection:
Abdomen is longitudinally distended and uniformly
Umbilicus is central and everted , flank are full
Linea nigra present and striae gravidarum present
No scars , sinuses , dilated veins
Palpation
No local rise in temperature or tenderness
After correcting dextrorotation , fundal height corresponds to term 32 weeks of gestation
Symphysiofundal height
Abdominal girth-80 cm
Fundal grip: soft, broad mass felt S/O breech
Umbilical grip:
Right - regular uniform, continuous curved resistance S/O spine
Left- irregular knob like structures S/O limb buds
1 st pelvic grip:
Smooth ,hard , not ballotable , mass felt S/O fetal head
2nd pelvic grip:
Fingers are diverging S/O head engaged
Auscultation
FHS are heard 140 bpm, regular rhythm
Summary
A 29 year old multigravida ( G3P1L1A1)
With B-ve at 10 week 1 day POG
Married to B+ve husband, spontaneous conception, presented for routine ANC visit and
currently asymptomatic, with no other comorbidities and no significant family history
On examination, a single live fetus with fundal height corresponding to 32 weeks of
gestation with flanks full , longitudinal lie , cephalic presentation and head is engaged , came
for institute evaluation and treatment
Diagnosis
A 29 year old G3P1L1A1 at 10 weeks 1 day POG with single live fetus , longitudinal lie ,
cephalic presentation, head engaged , with good LHS without medical and obstetric
complications not in labour came for institutional evaluation having Rh-ve isoimmunisation
Investigation:
CBC
Urine – albumin , sugar
Blood – sugar , urea , creatinine , bilirubin.
1. Blood grouping and typing
Reserve blood for delivery from blood blank
If blood grouping is B-ve , evaluate husband’s blood group
R.blood sugar
VDRL , HIV , Hbs Ag
2. ICT
3. MCA – PSV DOPPLER
4. USG
ABNORMAL UTERINE BLEEDING

Name: Mrs Sami
Age : 43 years
Address: Erkaumbadu
Occupation: farmer
Husband: Hariharan
Occupation: farmer
S.E.S. – Lower class according to modified Kuppuswamy scale
Obstetric score: P3 L3
Came to opd with chief compliants of heavy menstrual flow for the past 4
months, pain abdomen during menstruation for the past 4 months.
HISTORY OF PRESENTING ILLNESS
The patient was apparently normal before 4 months after which she developed
heavy menstrual bleeding during her cyclical menses which was insidious in nature,
progressive in nature with
20 days cycle
Each cycle lasting for 7-8 days
She changes 5-6 fully soaked pads per day
She also complaints of waking up at night to change her pads.
Associated with passage of clots.
H/o pain in lower abdomen during menstruation, intermittent in nature, aching type,
non-radiating, aggravated on doing work, relieved by taking medication.
H/o fatigue for past 4 months
No h/o any abdominal mass
No h/o vaginal discharge
No h/o intermenstrual, post coital bleeding
No h/o amenorrhea before periods
No h/o any bladder symptoms
No h/o constipation
No h/o significant weight loss
No h/o epistaxis/bleeding gums/bleeding from any other site
No h/o symptoms suggestive of thyroid dysfunction
No h/o intake of OCP
No h/o IUCD insertion
MENSTRUAL H/O
Attained menarche at the age of 14 years.
Past cycle:
30 days cycle
4-5 days of flow
2-3 pads/day
No h/o of pain or passage of clots
Present cycle:
20 days cycle
7-8 days of flow
5-6 pads per day
H/o of pain during menstruation; passage of clots
LMP:: 21-09-2021
MARITAL HISTORY
OBSTETRIC HISTORY
P3 L3
Conceived after 5 months of mrg;full term vaginal delivery; female 25 yrs
Full term vaginal delivery; female 23 yrs
Full term vaginal delivery; female 20 yrs
CONTRACEPTIVE HISTORY
No h/o any contraceptive use
Permanent sterilization-not done
PAST HISTORY
Not a known case of DM, TB, HTN, epilepsy, asthma, thyroid dysfunction
No h/o any blood transfusion
No h/o previous surgery
No h/o drug intake
FAMILY H/o
No h/o similar complaints in any of the family members
No h/o any bleeding disorders
PERSONAL H/o
Patient consumes mixed diet
Normal appetite
SUMMARY
A 43 year old, para 3 live 3, came with chief compliants of heavy menstrual bleeding
and pain during menstruation for the past 4 months.
GENERAL EXAMINATION
Patient is comfortable, cooperative, moderately built and moderately nourished.
Patient is anaemic
Not icteric
No cyanosis
No clubbing
No lymphadenopathy
No pedal oedema
Breast examination – normal
Spine examination- normal
Thyroid examination- normal

Height – 150 cm Weight-52 kg BMI -20.3
VITALS
Blood pressure- 120 / 30 mm Hg
Respiratory rate-16 breaths/ min
Pulse rate-80 beats/min
Temperature- afebrile
Other system examination

CVS-S1,S2 normal
RS-NVBS
CNS-NFND
ABDOMINAL EXAMINATION
After emptying the bladder and after getting consent;
INSPECTION
Abdomen- not distended
Umbilicus-midline and inverted
All quadrants move equally with respiration
No scars, sinus or dilated veins/visible pulsations seen over abdomen
PALPATION
Not warm and tender
No organomegaly
Soft
No mass palpable
PERCUSSION
All quadrants resonant
No shifting dullness/ fluid thrill
AUSCULTATION
Bowel sounds heard
Gynaec examination: external genitalia normal , no local lesions
P/V examination- not done
DIAGNOSIS
A 43 year old para 3 live 3 with abnormal uterine bleeding for evaluation with
anaemia
MANAGEMENT
Investigations
Haematological test- Hb, PCV, platelets, total count, bleeding time, clotting time, coagulation
profile
Thyroid function test
Pap smear
USG- TAS/ TVS
Hysteroscopy guided endometrial biopsy
TREATMENT
General- correct anaemia-hematric, vitamin and protein supplement
Medical
Non hormonal- NSAIDs, Transexamic acid, ethansylate
Hormonal- GnRH/ progestogen/OCP
MIRENA-IUD
SURGERY
Minimal invasive surgery
Ablative procedures
1st generation- TCRE
2nd generation- Radio frequency induced thermal ablation
Hysterectomy
Adenomyosis- adenomyomectomy
Fibroid- myomectomy
Chronic PID- laproscopic lysis of adhesions
Endometriosis- electrocautery or laser vapourisation
Varicose vessels- UAE
Von Willebrand disease- IV desmopressin
FOLLOW UP
Antibiotics
Iron supplements, vitamins, calcium supplements
Remove sutures on 10 th day
Follow up- review with HPE report
Don’t strain
Adequate rest
Don’t lift any heavy object
Coital abstinence for 6 weeks
Return to hospital of any complications
Look out for any post menopausal symptoms
DIAGNOSIS
43 year old premenopausal women with previous normal vaginal deliveries with AUB
with anaemia with no medical comorbidities for constitutional evaluation and treatment.
FIBRIOD
Name: Kannagi
Age: 37 years
Address:Melsozhanur
Occupation: Vegetable vendor
Educational status : middle school
Husband name :segar
Occupation : vegetable vendor
Status: low SES group (class 5)
Obstetrics score :P2L2
Came to OPD with the chief complaints of heavy menstrual flow for the past two
months
The patient was apparently normal before 2 months after which she developed complaints
of prolonged and heavy menstrual bleeding for the past 2 months
Insidious in onset
Intermittent in nature
3 cycles per month
Each cycle lasting for 7 – 8 days
She uses 5-6 per day
Presence of mass protruding through the introitus for the past 2 months
She also complaints of pain in the lower abdomen since 2 months during menstruation
Pain
Last for 7-8days
Intermittent
Dull aching type and non radiating type
Aggrevated on
Relieved by taking medication
No H/o discharge PV
H/O Post coital pain
No H/o fever, difficulty in micturition
No H/ o retention of urine
No H/o increased frequency of micturition
No H/ o difficulty in passing stools
No H/ o varicose veins
No H/o pedal edema
No H/o Abdominal distension
No H/o loss of appetite or unintentional weight loss
No H/o epistaxis, gum bleeding
No H/o symptoms suggestive of Thyroid dysfunction
No H/o intake of OCP
No H /o IVCD insertion
Menstrual history
Menarche -12 yrs
Past cycles :
30 days cycles
4-5days of flow
2-3 pads per day
History of dysmenorrhoea
No H/o passage of clots
Present cycle :
3 cycles per month
7-8 days of flow
5-6 pads per day
History of dysmenorrhoea
No H/o passage of clots
Obstetrics history
Married life -13 yrs of marriage (married at 24 yrs)
Obstetrics score :P2L2
First child : full term vaginal delivery
Female 12 yrs
Second child :full term vaginal delivery
Female 8 yrs
Contraceptive history
No H/ o any contraceptive used
Past history
Not a known case of DM ,TB ,HTN,Epilepsy ,asthma,Thyroid
No H/o any blood transfusions
No H/o previous surgery
No H/o drug intake
Family History
No H/o similar complaints in any of the family members
No H/o any bleeding disorder
Personal History
Patient Consumes mixed diet
Normal Appetite
Normal bowel and bladder movements
Summary
A 37 yrs old P2L2 came with the chief complaints heavy menstrual bleeding with mass
protruding through the introtious for the past 2 months and pain during menstruation since
2 months
General examination
The patient is conscious, cooperative, well-built and well-nourished.
Mild pallor present
No Icterus,Clubbing, Cyanosis,lymphadenopathy and edema
Weight-55kg
Height-164cm
BMI-20.5
Breast, Thyroid, Spine, skin-Normal
VITALS:
BP-120/80 mm Hg
RR-16 cycles per minute, Thoraco-abdominal type
PR-90 beats per minute
Temperature-Afebrile
ABDOMINAL EXAMINATION:
INSPECTION:
Shape of abdomen-flat distended
Umbilicus-central and inverted
All quadrants move equally with respiration
No scars, sinuses, dilated veins or visible pulsation seen over abdomen
PALPATION:
No local rise of temperature
Tender
Firm, smooth mass, mobile from side to side of 20 weeks of gravida uterus size is felt in the
midline.
The upper edge and the two lateral borders are smooth and lower border nor palpable
PERCUSSION:
Dull note is heard over the mass
AUSCULTATION:
Normal bowel sounds are heard
No audible bruit
PER VAGINAL EXAMINATION: Not done
SYSTEMIC EXAMINATION:
CVS:
S1 and S2 sounds heard
No murmurs heard
RS:
Normal vesicular sounds heard
No added sounds
CNS:
DIAGNOSIS: A 37 Year old lady P2L2 with AUB probably due to fibroid uterus without
comorbidities
MANAGEMENT:
INVESTIGATION:
1.Blood Investigation
2.TFT
3.USG
4.Per Speculum, Per vaginal examination(Transmitted Mobility)
5.PAP Smear
6.Endometrial Biopsy
7.UPI to be ruled out
TREATMENT:
Medical:
1.OCP
2.Mifepristone
3.SERM
4.Letrozole
Symptomatic,.
Pain-NSAIDS
Anemia-Ferrous sulphate
Surgical:
1.MYOMECTOMY
● Not completed family
● Nullipara
● Young patients
2.HYSTERECTOMY
● More than 40 years
● Completed family
● Malignancy
● Multipara
UTEROVAGINAL PROLAPSE
Mrs.poongavanam 61 yr old , who is a home maker from TVM with obstetric code:P3 L3
(NUD) belonging to low socioeconomic class came to OPD with chief complaints of mass
descending per vaginum for past 5 yrs.
The patient was apparently normal before 5 yrs after which she noticed mass descending
per vaginum which is gradual in onset , progressive in nature , reducing manually,
aggrevated by cough ,relieved by lying down.
Prolapse reducible or not
Causes of irreducibility : Edematous , congestion, long standing prolapse
H/O heavy weight lifting
H/O inconvenience while walking
H/O difficulty in initiating act of micturation
No H/ O bleeding PV
No H/O increased frequency of urination
No H/O burning micturation
No H/ O abdominal pain
No H/O vaginal discharge
No H/ O chronic cough, chronic respiratory disease
No H/O pelvic trauma
No H/O CT disorders
No H/O coital difficulty
No H/O fullness in the abdomen
No H/O low back ache
No H/O Sense of inadequate bleeding
No H/O incomplete evacuation of bowel
No H/O postmenopausal bleeding
No H/O constipation
Menstrual history
Attained menopause at age of 50 years
Attain menarche at 15 years
Regular cycle of 5 / 28 days
Used 2-3 clothes per day
No passage of clots
No postmenopausal bleeding
Marital history
Married at age of 21 years
No history of use of contraceptives
No H/O sterilization
Obstetric history
First pregnancy
Female child
39 years of age
Normal vaginal term delivery at home
Baby weighed 2.5 kg at birth and was breast fed
No H/O prolonged labour
No H / O instrument used
No H/ O complications during labour
No H/O early resumption of work
Second pregnancy
Female , 36 years of age
Normal vaginal term delivery at home
No H/O prolonged labour
No H/O instrument used
No H/O of Complications during labour
No H/O of early resumption of work
Third pregnancy :
Male child, 26 yrs of age
Normal vaginal term delivery at hospital
No H/O of prolonged labour
No H/O Of instrumental use
No H/ O of Complications during labour
No H/O of early resumption of work
Past history
She is a known case of diabetes since 8 years and is on oral hypoglycemic drugs
No H/O bronchial asthma, TB , epilepsy, hypertension
No H/O previous surgery
Family history
No H/O diabetes , TB ,asthma , epilepsy , CAD, hypertension in the family
No H/O similar complaints in the family
Personal history
Normal appetite
Normal bowel habits
H/O difficulty in initiating micturation
Summary
A 61 year old post menopausal multiparous P3L3 who is diabetic on medication with 2
vaginal term delivery , conducted at home and one NV institutional delivery, came with
mass descending per vagina , aggrevated on coughing and relieved by reducing manually
General examination
Patient is conscious ,oriented ,co operative, moderately built , nourished
No pallor , icterus, cyanosis, clubbing, generalised lymphadenopathy and pedal edema
Weight:48 kg
Height: 150cm
BMI : 21 .3 Kg /m2
Vitals
Temperature: afebrile
PR: 70 beats / min
RR: 18 breaths/ min
BP : 130/80 mm Hg
Spine , breast , thyroid- normal
Inspection
Abdomen is not distended
Umbilicus position is central and inverted
Corresponding areas move equally with respiration
No scars , sinuses , dilated veins seen
Hernial orifices are intact
Palpation
No local rise in temperature
No tenderness
Abdomen is soft
No palpable mass
No organomegaly
Percussion
All quadrants are resonant
No fluid thrill
Auscultation
Bowel sounds heard
Pervaginal examination
Inspection
6×8 cm size , pink globular mass protruding outside the introitus (3°)
No ulceration/ keratinization/pigmentation/rugosity /erosion / bleeding over the surface
Appears to bulging on straining
Cough impulse is positive
Palpation
Mass protruding can be reduced manually
No adenexal tenderness
No bleeding on touch
Not getting above the fundus of uterus -3°
Systemic examination
CVS – S1 , S2 sounds heard , no murmur heard
RS – normal vesicular breath sounds heard
No added sounds
CNS – no focal neurological deficit
Provisional diagnosis
A 61 year old post menopausal multiparous P3L3 who is diabetic on medication with 2
vaginal term delivery at home and one NV institutional delivery came with mass per vagina
propably UV Prolapse without other medical comorbidities came for institutional evaluation
and treatment
Management
Investigation
Routine: Hb , PCV , BT ,CT , platelet count, urine routine, blood sugar, ECG ,HIV HbsAg, VDRL ,
serum creatinine, RFT, LFT , chest x ray , TFT , blood urea ..
Specific:
● pervaginal examination
● Speculum examination
● PAP smear
● Cervical cytology
● USG
Treatment:
Confirm the diagnosis
Vaginal hysterectomy by removing uterus and cervix due to prolapse
OVARIAN MASS
MRS. Sundari, a 40 years old P3L3 , w/o Povamani who is a housewife and belonging to
lower socioeconomic class coming from Tiruvannamalai came to the OPD with the chief
complaints of :
1. Lower abdominal mass for past 6 months
2. Pain in the lower abdomen for the past 6 months
3. Menstrual disturbance since last 5 months.
History of presenting illness:
● The patient was apparently normal before 6 months after which she noticed a mass
in the lower abdomen. Initially, it was small in size and gradually increased in size till
it reaches the current size. The size of the lump does not vary with cough, posture or
on straining.
● The mass is associated with pain which is insidious in onset, dull aching type,
intermittent in nature, no radiation, aggravated on coughing and whole day heavy
work and relieved my taking rest.
● The patient complains of irregular periods since last 5 months. She developed HMB
during her cycle menses which was insidious in onset , progressive in nature with
throughout the month.
● She changed 5-6 fully soaked pads/day.
● h/o of waking up at night to change her pads associated with clots and associated
with pain.
● This episode of HMB was followed by a period of amenorrhea of 3 months duration
after which she developed normal menses last month.
● h/o of dyspnea and fatigue
● No h/o urinary symptoms
● No h/o constipation
● No h/o pedal edema, varicose vein
● No h/o dyspareunia
● No h/o vaginal discharge
● No h/o nausea, vomiting, dyspepsia
● No h/o loss of appetite and weight
● No h/o fever
● No h/o yellowish discolouration of skin eyes and urine.
● No H/o lump or discharge from breast
● No H/o bone pain
● No H/o chronic leg pain or swelling
● No H/ o significant weight loss.
Past history:-
● No h/o similar complaints in the past
● Not a known case of diabetes, HTN,TB, asthma, CAD, epilepsy and thyroid disorder.
● H/o blood transfusion
● H/o sterilization surgery done 14 year ago
● No h/o any drug intake
Menstrual history:-
● Menarche attained at 13 yrs of age
● Past cycle – regular cycles of 5/28 days , 3 pads/day, not associated with clots and
pain.
● Present cycle – her LMP was on 15/09/2020. It lasted for 3 days changed 3 pads/day
not associated with clots and pain.
Martial history:-
● Married since 18 yrs non consanguineous marriage.
Obstetrics history:-
P3L3
Ist pregnancy – spontaneous conceived after 1 month of marriage, female child ,full term
normal vaginal delivery is institution AN and Rn h/o Uneventful .Now the child is 18 Years
Old.
2nd Pregnancy: Spontaneous Conception 1Year after 1st Pregnancy .A full term Male Baby by
Normal Vaginal delivery in institution. An and pn period uneventfull currently 16 yrs old.
3rd pregnancy: spontaneous conception after 1 yr of previous pregnancy, a full term male
bady by normal vaginal delivery in institution. An and Pn period uneventfull currently 14
years old.
No h/o any contraceptive usage in the interpregnancy period.
She underwent sterilization surgery 2 days after the delivery of her 3rd child.
Family history:-
No h/o similar complains in the family.
No h/o any maliganancies in the family.
Personal history:-
Consumes mixed diet
Normal sleep pattern.
General examination:-
The patient is comfortable , oriented to time, place, and person, cooperative, moderate built
and nourished.
The patient is anemic
Not icteric
No cyanosis
No clubbing
No pedal edema
No generalized lymphadenopathy
Ht- 155 cm
Wt-50kg
BMI- 20.8
Breast, thyroid, spine are normal
Vitals:-
Temp-98.4f
RR -16 breaths/min
PR – 80beats/min
BP – 110/70mm Hg
Other systemic examination:-
CVS- s1,s2 heard no murmur
RS – normal vesicular breath sounds heard , no added sound
CNS – no focal neurological defects
Abdominal examination :-
After emptying the bladder and after getting consent
Inspection:-
● Abdomen distended in the lower quandrant
● Umbilicus – midline and inverted
● All quadrants move equally with respiration
● Striatum Albian is seen.
Palpation :-
● Inspectory finding are confirmed
● Not warm not tender
● No organomegaly
● A single mass of size 5*10,occupying hypogastric and both the iliac region ,
corresponding to 18 wks of gestation, irregular surface, variable in consistency,
mobile in hypogastric plane. All the borders are palpated.
Percussion :-
Dullness over the mass
No free fluid present
Auscultion:-
Normal sounds heard
External genitilia – normal
Per speculum examination – not done
Pv examination – not done
Summary :-
A 40yr old P3L3, belonged to lower socioeconomic class came with the chief complains of
pain and lump in the lower abdomen since last 6months associated with AUB. No h/o loss of
weight and appetide, no pressure symptoms, she was anemic , a mass occupying hypogastric
region and both iliac region which is 8*11cm in size , variable in consistency, irregular
surface and mobile in horizontal planes. all borders are palpated. On percussion, the mass
was found to be dull.
Diagnosis:
A 40 yr old P3L3 came with pain and lump in lower abdomen probably benign ovarian tumor
with no other medical complications came for institutional evaluation and treatment.
LEUCORRHEA
Mrs. Kasiyammal, 51 years old P2L1 W/o Ravi who is a housewife, belongs to lower
socio-economic class coming from Tiruvannamalai came to the OPD with the chief
complaints of
(i) Excessive white discharge for the past 3 months
(ii) H/o pain in the lower abdomen and back for past 3 months
HISTORY OF PRESENTING ILLNESS:

The patient was apparently normal before 3 months after which she developed white
discharge which was insidious in onset, progressive in nature, mucoid in consistency, no
odour, not blood stained, not associated with itching.
H/o of pain the lower abdomen and lower back for past 3 months which was insidious in
onset and progressive in nature associated with discharge.
No H/o pruritus
No H/o dysuria
No H/o local drug application
No H/o allergy
No H/o pediculosis
No H/o scabies
No H/o use of intrauterine contraceptive devices
PAST HISTORY:
No H/o similar complaints in the past
Known case of diabetes, hypertension, hypothyroid, renal disease
Not a known case of TB, asthma, epilepsy
No H/o blood transfusion
No H/o drug intake
MENSTRUAL HISTORY:
Menarche attained at 14 years of age
Regular cycles of 5/28 days, 3 pads per day
Not associated with clots and pain
Menopause at the age of 50 years
MARITAL HISTORY:
Non-consanguineous marriage
OBSTETRIC HISTORY: P2L1
First child:-
Spontaneous conceived after one month of marriage
Male child, full term vaginal delivery in institution, Antenatal and Postnatal history
are uneventful
Child died at the age of 25 years in an accident
Second pregnancy:-
Spontaneous conception 1 year after first pregnancy
A full term male baby delivered by normal vaginal delivery in institution
Antenatal and Postnatal history are uneventful, currently 26 years
CONTRACEPTIVE HISTORY:
She underwent permanent sterilization after the delivery of second child
FAMILY HISTORY:
No H/o similar complaints in the family
No H/o any malignancy in the family
PERSONAL HISTORY:
Consumes mixed diet
SUMMARY:
A 51 year old multiparous, postmenopausal women P2L1 with previous 2 NVD who is
a known DM, HTN, hypothyroid, renal disorders under medications came with chief
complaints of white discharge for the past 3 months and pain in the lower abdomen
and back for past 3 months.
GENERAL EXAMINATION:
The patient is comfortable, and cooperative
Moderately built and nourished
The patient is not anaemic
Not icteric
No cyanosis
No clubbing
No pedal oedema
No generalised lymphadenopathy
Height – 155 cm
Weight – 50 kg
BMI – 20
Breast
Thyroid Normal
Spine
Gait
VITALS:
Temperature – 98.4° F
Respiratory rate – 16 breaths per minute
Pulse rate – 80 beats per minute
Blood pressure – 100/70 mm Hg
OTHER SYSTEM EXAMINATION:
CVS:-
S1, S2 heard
No murmur
RS:-
No added sounds
CNS:-
NFVD
SYSTEMIC EXAMINATION:
Abdominal examination:-
INSPECTION:
Abdomen – not distended, umbilicus is in midline, inverted
Flanks free
Healthy midline vertical scar of 4 cm – suprapubic region is present
No sinus, no dilated veins
Hernial orifices – free
PALPATION:
Not warm, not tender
Soft
No organomegaly
PERCUSSION:
No shifting dullness
AUSCULTATION:
Bowel sounds heard
GYNEC Examination:
Pubic hair:- Sparse
Labia majora, minora:- Normal
Urethral meatus:- Clitoris – normal
Vulva:-
No redness
No scratch marks
No signs of inflammation
DIAGNOSIS:
A 51 year old multiparous, postmenopausal women P2L1 who is a known DM, HTN,
hypothyroid, renal disorders under medications diagnosed as abnormal vaginal
discharge for evaluation.
INVESTIGATIONS:
Routine investigations:-
Blood investigation: TC, DC, ESR, Hb %
Blood sugar
Blood urea
Serum creatinine
LFT
Urine analysis – sugar, albumin
High vaginal swab and cervical smear – Gram stain
SDA, Blood agar
PAP smear
VIA, VIL1, Colposcopy
Specific investigations:-
Wet film
Whiff test
TREATMENT:
Medical treatment:-
Cefoxetine - 2 gm iv every 6 h
Doxycycline - 100 mg iv, followed by oral route
INFERTILITY
Mrs .chandra , a 25 year old W/o Mr.Kumar ,30 years coming from thiruvanamali who is
house wife by occupation , belonging to upper lower socioeconomic class , studied upto 12
th std .. came to OPD , with C/O inability to conceive for the past two years..
History of presenting illness:

The patient is unable to conceive after 2 years of regular and unprotected intercourse
H/O acne present
H/O weight gain
H/O hair growth around mouth and jaw. ( hirsutism) for past 2 years - PCOS
No H/O white discharge PV
No H/O fever- PID ( tubal block )
No H/O chronic cough or loss of weight – TB – Tubal block
No H/O vulval itching/ genital ulcers-STI – Tubal block
No H/O cold Intolerance, lethargy, hoarseness of voice – hypothyroidism – anovulation
No H/O tremors / palpitations- hyperthyroidism
No H/O abnormal milk secretion – Hyperprolactinemic
No H/O previous abortion, pregnancy, postabortal curettage
No H/O previous abdominal and pelvic surgery- adhesions and tubal block
No H/O drug intake for any psychiatric disorders
Menstrual history:
She attained menarche at 14 years of age
H/O period of amennorhea followed by profuse bleeding not associated with pain but
associated with clots for the past 7 years
Present cycles:
Cycles are irregular
Periods once in two months
Each cycle lasting for four to five days
Changing 4 pads per day( totally 6 cycles per year )
H /O passage of clots not associated with pain
Past cycle :
Regular
28 days cycle
Lasting for 3-4 days
Change 2-3 pads per day
No H/O pain / passage of clots
Marital history:
Married since two years
She is living with her husband
Coital history :
Frequency of intercourse : 4- 5 days / week
No H/O dyspareunia
No H/O vaginismus
No H/O contraception use
No H/O hypospadias / epispadias in husband
Aware about fertile period and ovulation
Andrological history:
Husband- Mr. Kumar, 30 years old working as farmer
No H/O heat / radiation exposure
No H/O frequent travel and shift of duties
H/ O smoking (2 cigarettes per day) and occasional alcoholic
No H/ O genital ulcer and dysuria
No H/O mumps in adolescent period
No H/O chronic cough with expectoration
No H/O chest infection/UTI
No H/O trauma to genitals
No H/O diabetes
No H/O drug for hypertension and psychiatric disorders
No H/O surgery in inguinal region ,urethra , hydrocele surgery
No H/O sexual dysfunction
No H/O cloudy urine after ejaculation
Past history:
Not a known case of DM , HTN , CAD ,TB , epilepsy ,asthma
No previous H/O evaluation or treatment for infertility
No H/O surgery/ invasive procedures
Personal history:
Family history:
No relevant family history
Treatment history:
H/O OCP intake for treatment of PCOD ( on and off for past seven years )
Summary :
A 25 year old married since 2 years living with her husband came with C /O inability to
conceive after 2years of regular and unprotected intercourse with H/O acne , weight gain
and hirsutism
General examination:
The patient is conscious, oriented, co operative, moderately built , nourished
No pallor , icterus ,cyanosis , clubbing, generalised lymphadenopathy and pedal edema
Height : 160cm
Weight:70 kg
BMI :27.3
Vitals :
Temperature: afebrile
PR: 85 /min
BP :120/80mm Hg
RR: 16 breaths /min
Examination of
Breast and thyroid- normal
Spine and gait – normal
CVS- S1 ,S2 heard , no murmur
RS - NVBS , no added sounds
CNS – no focal neurological deficit
Inspection:
Abdomen not distended
Umbilicus in midline and inverted
No scars , sinuses , dilated veins ( or visible pulsations)
Palpation:
Soft , not warmth , non tender, no organomegaly
No palpable mass
Percussion:
All quadrants are resonant
No fluid thrill or shifting dullness
Auscultation:
Normal bowel sounds heard
Genital examination:
External genital normal
No focal lesion
Speculum examination: not done
PV , PR : not done
Diagnosis:
A 25 year old married since two years with inability to conceive after 2 years of regular and
unprotected intercourse probably a case of primary infertility with PCOD with no medical
comorbidities came for institutional evaluation and management.
Investigations:
Hb
Blood grouping / typing
BT/CT
RBS
Blood urea creatinine
Urine – albumin, sugar
TFT , RFT , LFT
Viral markers – HIV , VDRL , Hbs Ag
Insulin levels
Serum testosterone, androgen
Female :
USG abdomen and pelvis
Serum prolactin ( >30 ng / ml )
PAP smear
Test for ovulation
Test for ovarian reserve
Test for tubal patency
Male :
Semen analysis
TFT
Serum prolactin
Anti sperm antibodies
Serum testosterone , FSH , LH hormonal assay
USG – scrotum
Karyotyping
Testicular biopsy
Management:
- Counselling the couple about basics of reproduction, fertile period
- Treatment: lifestyle modification+ metformin
- Correct irregular cycles by giving ocps for two to three months
- Ask the patient to come on 2 nd day of cycle and give clomiphene citrate 50 mg / day
× 5 days
- Follicular study from day 10 of cycle on alternate days
- Look for increased size of follicles and endometrial thickness
- When follicular size is 18 to 20 mm , give injection HCG 5000 IU
- Ask patient to have intercourse / IUI can be done after 24 hrs of injection HCG
- Await onset of menses or perform UPT , can be done for 6-8 cycles
- If it fails- ART , FSH , HCG therapy
- Laproscopic drilling

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GOVERNMENT TIRUVANNAMALAI

GESTATIONAL DIABETES MELLITUS

Past obstetric History.

Conceived 2 months after marriage with H/o malpresentation,

No H/o Diabetes mellitus, Hypertension,Tuberculosis, Epilepsy, Asthma.

Consumes mixed die

Obstetric Examination:After getting consent from the patient,emptying the

POST DATED DELIVERY

HOPI: She is booked and immunized in nearby PHC.

Folic acid tablets were taken regularly

Fetal movements are well perceived

Underwent routine lab tests and now Hb was improved

PGE2 Gel or Misoprostol- BISHOP<6

• Go for ARM only when she is in active labour

CEPHALO PELVIC DISPROPORTION

Booked &Immunised at KMC

Gestational Age -38 weeks +5days

No h/o pain abdomen

No h/o bleeding or draining PV

Fetal movements are perceived well

H/O present pregnancy:

• Spontaneous conception after 1 yr of marriage .

• H/O morning sickness present .

• Quickening felt at 20 weeks.

• Fetal movements are well perceived.

• Growth scan was done and found to be normal.

• Married since 1yr ,non consanguinous marriage.

• Consumes mixed diet & N appetite

• No H/O DM ,HTN,TB in family.

Mrs.xyz,a 22yr old,primigravida with LMP-7.3.2020 &EDD - 14.12.2020 at 38 weeks +5days

General physical examination:

• Patient is conscious, oriented ,comfortable,cooperative.

• Abdomen is longitudinally distended, flanks- full.

• Fundal height corresponds to 32 weeks of gestation which corresponds to term

Lt side - smooth ,curved ,hard uniform resistance felt -probably spine .

Rt side -multiple small nodules are felt -probably limb buds .

1st Pelvic grip-hand,round,independently ballotable mass -probably head

Major CPD -overriding of head with PS

Abdominopelvic assessment of CPD and PV examination to be done.

• Fetal heart sounds heard at left spinoumbilical line below umbilicus.

• RS: Normal vehicular breath sounds heard .

• CVS: S1,S2 heard .no nurmurs.

live fetus ,longitudinal lie,cephalic presentation ,head is mobile . On abdominal method

ABNORMAL UTERINE BLEEDING

Normal bowel and bladder habits

Other system examination

HISTORY OF PRESENTING ILLNESS:

History of presenting illness:

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