CLINICAL CASE PRESENTATION-

OBSTETRICS & GYNAECOLOGY

MELWIN MABEN
FINAL YEAR MBBS
HIMS, HASSAN
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Name: Mrs. XYZ
Age: 32 years
Sex: Female
Address: Vidyanagar, Hassan
Occupation: Housewife
Education: PUC
Husband’s Details: Mr. XYZ, 38 years, Company worker, Educated
up to Degree.
Socioeconomic status: Class 2 of Modified BG Prasad
Classification
DOA: 8th May 2019
DOE: 6th March 2019
LMP: 31st August 2018
EDD: 7th June 2019
Obstetric Score: G3P2L2A0

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CHIEF COMPLAINTS
Admitted with reduced growth of fetus
on serial ultrasound since last 4 weeks

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HISTORY OF PRESENT ILLNESS
Patient was told to have reduced growth of
fetus on serial ultrasound since last 4 weeks
and was admitted for close monitoring.
She is perceiving fetal movements well
No h/o leaking per vaginum
No h/o bleeding PV

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 HISTORY OF PRESENT PREGNANCY
First Trimester:
-Spontaneous Conception
-Pregnancy was confirmed after 1 ½ months of missed period by
UPT and she was a booked case at HIMS.
-Regular ANC visits
-Booster dose of Td vaccine taken
-Folic Acid tablets were taken
-First Trimester (Dating Scan) was done and was told normal
No h/o excessive vomiting.
No h/o fever with rashes, excessive vomiting.
No h/o spotting or bleeding per vagina.
No h/o pain abdomen.
No h/o exposure to radiation and drug intake.
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Second Trimester:
-Quickening was felt at 5 months of gestation
-Second Trimester(Anomaly Scan) was done and no
anomalies were found.
-Iron and Calcium Tablets were taken
-No History of fever with rashes
-No History of any drug intake or radiation exposure
-No History of Per vaginal bleed
-No H/o Pedal edema or headache
-No H/o Raised BP Recording or Raised Blood Sugar
recording

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Third Trimester:
 Fetal movements are well perceived
 -Iron and Calcium tablets taken
 USG was done at 32 weeks which showed some
difference in the growth of the fetus. A repeat scan
after 2 weeks was advised, which showed no
significant increase in growth of the fetus. She was
told that last USG taken 2 days back showed mild
changes in the blood supply to the fetus and was
advised hospitalization.
 No h/o high Blood pressure or pedal edema
 No h/o abdominal pain.
 No History of Per vaginal bleed/leak per vagina 7
PAST OBSTETRIC HISTORY
Married at 20 years of age and concieved
spontaneously 3 months after marriage.
1 pregnancy:
st

No h/o any antenatal complications

Induced at 40 weeks. Emergency LSCS done in view
of fetal distress and meconium staining of liquor .
Baby cried after stimulation and admitted in NICU for
2 days.
Female baby, 2.5 kg, 11 yrs now
No adverse events in postpartum period
Baby did well after discharge from ICU,
Developmental milestones normal, Presently alive
and healthy.
Breastfed for 1 and ½ yrs.

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 2nd Pregnancy:
 Concieved spontaneously while in lactational amenorrhoea.
 No h/o medical disorders complicating pregnancy.
 H/o reduced growth for the fetus in USG at around 32 weeks
of gestation.Regular follow up scans were done and repeat
CS was done at 37 weeks in view of changes in blood flow
to fetus and scar tenderness.
 Delivered a female baby weighing 2.8kg , cried soon after
birth.
 Breastfeeding initiated 1 hr after birth, and was fed till 2
years of age
 No puerperal complications
 Baby’s developmental milestones were normal. Presently 9
years.
 Used barrier method of contraception after delivery.

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PAST HISTORY
No h/o DM, HTN, Asthma, TB or cardiac
diseases
No h/o previous surgeries other than
LSCS
No h/o drug allergies
No h/o previous blood transfusions

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 MENSTRUAL HISTORY

Menarche: 14 years
Past cycles:
28 days cycle 3-4 days of flow
2-3 pads/day No H/o Dysmenorrhea,
passage of clots

LMP: 31st August 2018

EDD: 7th June 2019

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FAMILY HISTORY
No history bleeding disorder in the family.
No history of children with chromosomal anomaly
/birth defect.

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PERSONAL HISTORY
 Diet: Mixed
 Appetite: Normal
 Sleep: Undisturbed
 Bowel and Bladder: Normal and regular
 No H/o any addictions

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 DIETARY HISTORY
 Non vegetarian diet
 Breakfast : 3 dosas, coconut chutney, 1 cup tea  550
cal, 6 grams protein
 Midmorning snack: 1 banana, 1 cup milk  220 cal , 3
grams protein
 Lunch : 2 cups of rice , 1 katori sambar,1 cup pulses,1
piece of fish 450 cal, 30 grams protein
 Evening snacks: 1 handful peanuts, 1 cup tea, 2
biscuits 320 cal, 20 grams protein
 Dinner : 3 chapathi dressed with ghee, Egg curry  500
cal , 14 grams protein
 TOTAL  2000 cal , protein 73 grams

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SUMMARY
A 32 year lady with an Obstetric Score of G3P2L2A0
with 9 months of amenorrhea was admitted with
complaints of reduced fetal growth seen on serial
ultrasounds since 4 weeks. She can perceive fetal
movements well and has no other complaints.

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GENERAL PHYSICAL EXAMINATION
Here is a young lady who is
moderately built and nourished. She
is conscious, cooperative and well
oriented to time, place and person.
Weight – 59 kg
Height – 150 cm
BMI – 26.22 kg/m2
Pallor, Icterus, Clubbing, Cyanosis,
Lymphadenopathy, Edema: Absent
Breast, Spine, Thyroid: Normal
VITALS
Pulse rate – 70 beats/min, regular
rhythm, normal volume, normal
character
Blood pressure – 120/80 mmHg.
Taken from left hand in sitting
position
Respiratory rate – 14 cycles/min,
thoraco-abdominal type
Temperature – 98.6 F
OBSTETRIC EXAMINATION
 INSPECTION
Shape of the abdomen- Distended and appears
longitudinally oval.
Flanks: Full
Umbilicus is central and everted.
Linea nigra and Stria gravidarum: Present.
No scars, sinuses or dilated veins can be seen.
Hernial orifices are intact.
PALPATION
No local rise of temperature or
tenderness.
Abdominal Girth: 31 inches
Fundal height: 32 weeks
Symphysio-fundal height: 31 cm
Liquor clinically appears mildly
reduced
EFW clinically appears 2 kg
OBSTETRIC GRIPS :
Fundal grip : Soft broad mass felt on suggestive of fetal
breech.
Right Lateral grip : Uniform, continuous curved resistance
suggestive of spine.
Left lateral grip : Irregular knob like structures suggestive of
limb buds.
1st Pelvic grip : Hard, non ballotable globular mass felt
suggestive of fetal head
2nd Pelvic grip : Fingers are diverging
AUSCULTATION :
 Fetal Heart sounds heard in the left spino umbilical
line – 140 bpm
 SYSTEMIC EXAMINATION
Cardiovascular system
S1, S2 sounds heard, no murmurs
heard

Respiratory system
Normal vesicular sounds heard
No added sounds

Central nervous system

No focal neurological deficit
SUMMARY
A 32 year lady with an Obstetric Score of
G3P2L2A0 with 9 months of amenorrhea was
admitted with complaints of reduced fetal growth
seen on serial ultrasounds since 4 weeks. She
can perceive fetal movements well and has no
other complaints.
Her vitals are normal and on obstetric
examination, a live fetus is palpated with
symphysio-fundal height corresponding to 32
weeks of gestation and expected fetal weight of 2
kg with hard, non ballotable mass palpated on
First pelvic grip suggestive that the fetus is
Cephalic in presentation with non-engaged head.
Fetal heart sounds are heard and are normal.
PROVISIONAL DIAGNOSIS
A 32 year old lady with obstetric
index G3P2L2A0 with two previous
LSCS, with 36 weeks of gestation,
with single live fetus, in
longitudinal lie, Cephalic
presentation, not in labour and is
probably a case of Fetal Growth
Restriction.