The Case of E.S.

Identifying Data: Eliza Seno is a 26- year old, G1P0 (0000), Filipina, unemployed , single, Iglesia ni Cristo from Sandiganbayan, Quezon City who had her fourth prenatal checkup at Quirino Memorial Medical Center on May 22, 2012 Source and Reliability: Information was gathered from the patient herself; she seemed to have good reliability.

OB History
G1P0 (0000) LMP: November 10, 2011 AOG: 28 weeks and 3 days EDD: August, 17 ,2012

(-) abortions Menstrual History

Menarche: 12 years old Interval: 30 days, regular Duration: lasts for 5 days Amount: 3 pads/day Severity: moderate (+) dysmenorrhea (-) intermenstrual bleeding Chief Complaint: hindi masyado magalaw ung isang baby ko History of Present Pregnancy Patient was regularly menstruating until five months prior to consult when she noted of missed menses. Patient had been sexually active, with frequency of coitus noted to be at four times per month with one partner. Patient undertook a pregnancy test, where she tested positive. There was no associated headaches, dizziness, breast tenderness, nausea, abdominal pain, easy fatigability and low back pain. Patient did not seek consult with a health professional at this time. Patients condition remained the same until three months prior to consult when she first experienced loss of appetite and shortness of breath. There was no associated headache, dizziness, breast tenderness, nausea, abdominal pain, easy fatigability, and low back pain. Patient did not seek consult with a physician. Patients condition remained the same until two months prior to consult when she first noted of fetal movements. Due to sensation of fetalmovements, patient decided to have her first prenatal checkup on April 17, 2012 at the Obstetrics and Gynecology Outpatient Department (OB/GYN OPD) of the Quirino Memorial Medical Center, where she was advised to undertake a pelvic ultrasound. Results from the ultrasound revealed that the patient had two intrauterine alive fetuses. She had her second prenatal checkup at the Obstetrics and Gynecology Outpatient Department of the Quirino Memorial Medical Center on April 23, 2012, where she was referred to the perinatology department of the QMMC. She had her third prenatal checkup at the Perinatology Outpatient Department of the Quirino Memorial Medical Center on May 5, 2012, where she was advised to undergo a repeat pelvic ultrasound. Results from the ultrasound indicate that the patient had a multifetalpregnancy (cephalic-breech) monochorionic diamnionic type, with intertwin discordancy of 34%. Patient had her fourth prenatal checkup at the Perinatology Department of the Quirino Memorial Medical Center on May 22, 2012 , where patient noted of good fetal movements on her lower

right abdominal area, and poor fetal movements on her left abdominalarea. Due to poor fetal movements of one of her fetuses, she was advised to be admitted at the Obstetrics and Gynecology Emergency Room.

-regularly menstruating until 5 months PTC, noted missed menses -sexually active, frequency of coitus 4x /month -tested positive with a pregnancy test -no headaches, dizziness, breast tenderness, nausea, GI pain, easy fatigability, low back pain -did not seek consult with health professional -condition remained the same till 3 months PTC, experienced loss of appetite and shortness of breath -still no headache, dizziness, breast tenderness, nausea, abdominal pain, easy fatigability, low back pain -did not seek help with a physician -condition stable till 2 months PTC, noted of fetal movements -due to sensation of fetal movements, wentf for first prenatal checkup on April 12, 2012 at OB OPD, QMMC (advised to undergo pelvic UTZ) -ultrasound revealed two intrauterine alive fetuses - second prenatal checkup at OB OPD- april 23, 2012-referred to perinatology dept QMMC due to twin pregnnacy. -Third prenatal checkup at perinatology OPD May5, 2012- advised to undertake repeat pelvic UTZ. -Repeat UTZ revealed multifetalpregnancy (cephalic-breech) monochorionic diamnionic type, with intertwin discordancy of 34%. 5 hours PTC, Px noted good fetal movements on right, and poor fetal movements on left (+) edema of lower extremities (+) breast- minimal, whitish, thick discharge (-) nausea/vomitting (-) headache (-) dizziness (-) vaginal bleeding (-) fever, chills (-) dysuria (-) abdominal pain (-) pelvic pain (-) blurring of vision Due to poor fetal movements of one of her twins, sought consult at the perinatology OPD. Sexual History Age on 1st coitus- 20 years old Number of sexual partners 7 Frequency of coitus- 4 times per month (-) dyspareunia Contraceptives Use (-) pills (-) Natural family planning method

(-) condoms (-) injectables (-) IUD (-)HRT Review of Systems General. (-) Weight changes Skin. (-)rashes, (-) skin changes Head, Eyes, Ears, Nose, Throat (HEENT) Eye: (-) eye problems Ears: (-) hearing difficulty on both ears, no tinnitus, nor vertigo, nor ear infections. Nose, sinuses: (-) colds, (-) sinus problems. Throat: (-) hoarseness Neck. (-) lumps, (-) goiter, (-) pain. (-) swollen glands. Respiratory: (-) cough, (-) wheezing Cardiovascular. (-) orthopnea, (-) chest pain, (-) palpitations Gastrointestinal. (-) indigestion, (-) changes in bowel movements (-) diarrhea, (-) bleeding. (-) jaundice Urinary. (-) frequency, (-) dysuria, (-) hematuria, (-) recent flank pain, (-) nocturia Genital. (+) vaginal discharge= yellow-white, thick, moderate in amount, foul-smelling Peripheral vascular. (-) history of phlebitis, (-) leg pain Musculoskeletal. (-) joint pains Psychiatric. (-) history of depression. Neurologic. (-) fainting, (-) seizures, (-) motor or sensory loss Hematologic. (-) easy bleeding, (-) anemia Endocrine. (-) temperature intolerance, (-) excessive sweating, (+)polydipsia, (+) polyuria Past Medical History UTI- 16 years old- resolved with antibiotics Recurrence of UTI- 22 years old- resolved with water therapy (+) anemia (-) Pertinent childhood illnesses (-) HPN (-) DM (-) PTB (-) cancer (-) asthma (-) heart disease (-) kidney disease (-) surgeries (-) allergies to food and drugs Incomplete immunizations (unrecalled) Family History Family of M.G. November 21, 2011

Father

Mother

Sibling 1, Sibling 2, Sibling 3, Sibling 4,

Sibling 5

px,

Sibling 7

(+) PTB- paternl uncle, paternal grandfather (+) HPN- mother, maternal grandmother (-) cancer (-) DM (-) heartdisease (-) allergies (-) drug reaction (-) asthma (-) history of twin pregnancies Personal and Social History Previously worked as a cashier but stopped December 2011 after confirming that she is pregnant Lives in a 54 square meter house in Sandiganbayan QC with his parents, 6 siblings, and grandmother, and 6 nieces Smoking- 1 cigarette stick per month for the past 3 years Alcohol- 2x month per occasion, drinks 1 liter of Red Horse and Tanduay Ice Educational attainment: finished high school Ususal diet: Breakfast- bread, coffee (1x / week), milk (2x / day) Lunch- rice + pork/chicken/fish Merienda- banana cue or bread Dinner rice + pork/chicken/fish

Stakeholders Analysis:
Stakeholder E.S. Partner Interest in Issue High High (the partner regularly visits the patient in the OB ward) High High High Moderate Moderate Moderate Moderate Moderate Role Dependent Secondary bread winner Level of Influence High High (partner helps in deciding what actions to take whenever the patient gets sick) High High High Moderate Moderate Moderate Moderate Moderate

Father Mother Grandmother Sibling 1 Sibling 2 Sibling 3 Sibling 4 Sibling 5

Breadwinner Primary Caregiver Secondary caregiver Dependent Dependent Dependent Dependent Dependent

Sibling 6 Sibling 7

Moderate Moderate

Dependent Dependent

Moderate Moderate

Physical Examination: General apperance: coherent, alert