Case summary and examination of Obstetrics Posting

Case summary and examination of Obstetrics Posting Madam NTR is a 34 years old Malay lady with gravida 4 and parity 3, currently at 37 weeks of gestations. She was admitted on 21st Nov 2010 at gestational age of 30 weeks and 1 day, due to referral from Health Clinic Sendayan in view of placenta previa based on ultrasound findings during a routine antenatal visit. Her estimated date of delivery was on 20th Jan 2011. She was asymptomatic with no complaints of per vaginal bleeding, contraction pain, leaking liquor or show. Fetal movements were felt and were not reduced. She has no history of placenta previa in her previous pregnancies. The first day of her last normal menstrual period was on 15th Apr 2010. This was an unexpected pregnancy but both her and her husband wanted it. She suspected she was pregnant when she missed her menses for 4 weeks. She confirmed her pregnancy after urine pregnancy test done in a private clinic yielded positive result. Booking was done in Maternal and Child Health Clinic Gadong at 16 weeks of gestation a nd the dating scan at 16 weeks revealed parameters corresponding to date. However, placenta was noted to be low lying during that scan. Throughout her routine antenatal visits, she was normotensive, not anaemic and did not have diabetes mellitus. HIV and VDRL test were negative. Her blood group type is O Rh DÂ  positive. This is her fourth pregnancy. Her third pregnancy was in the year of 2007. She delivered a full term baby boy with birth weight of 2.6 kg via caesarean delivery due to breech presentation in Hospital Tuanku Jaafar Seremban. She delivered her first two children who are both males in the year of 2004 and 2005 via spontaneous vaginal delivery, with birth weight of 4.26kg and 2.6kg respectively. There was no history of shoulder dystocia. All her children were born alive and well. Antenatal, natal and postnatal for all previous pregnancies were uneventful. She attained menarche at the age of 12. It is regular at 28 to 30 days cycle with duration of 5 to 7 days. There wa s neither dysmenorrhea nor menorrhagia. She practised coitus interuptus as contraceptive measure. She never had any PAP smear done previously. Past surgical, medical and drug history were unremarkable. Family history was unremarkable. She and her husband are married for 7 years. They are staying together with their three children in Gadong Jaya Village. She is a housewife. She neither smokes nor drinks alcohol. On the other hand, her husband works as a construction worker. He is a smoker but not alcoholic. Family income is approximately RM2000 per month which is barely adequate for their living. Physical examination: Madam NTR was alert, conscious and communicative. She was not in pain or respiratory distress. Her height and weight are 165cm and 76kg respectively. Her blood pressure was 110/80 mmHg; pulse rate was 86 beats per minute of regular rhythm and strong volume; temperature was 37Â ° C; respiratory rate was 19 breaths per minute. All vital signs were within normal range. Up on general examination, there was no conjunctival pallor, sclera jaundice, palmar erythema or peripheral cyanosis. Thyroid glands were not palpable and breast examination was unremarkable. There was bilateral pedal edema up to mid-shin. Cardiopulmonary examination was unremarkable.