OBGYNE

Case
{ presentation

FH
32 years old
G1P0
38 5/7wks AOG
LMP: NOV 9, 2013
EDC: Aug 16, 2014

LABOR
PAINS

10
month
PTA
7
months
PTA

6
months
PTA

Sudden onset of diplopia accompanied with ptosis of the right

eye lid. Symptoms decreased with rest and sleep. Consulted to
an ophthalmologist and was requested for cranial CT MRI,
Ach Ab, TSH but results revealed inconclusive thus patient
prescribed with eyeglasses and was sent home.

Condition persisted with history of 2 months absence of

menstruation.Urine pregnancy test done at home and
revealed positive. No other further work-up done.

Patient 1st prenatal visit and was given with Folic Aid
and Calcium supplements. She was referred to an
Endocrinologist. Thyroid panel requested and revealed
normal results..

5 months
PTA

Consulted to a neurologist and requested with following

tests. Nerve conduction test result borderline and Single
Fiber EMG which confirmed that patient had Myastenia
Gravis. She was then prescribed with Pyridostigmine- 60mg
OD then increased to 60mg TID for 3 and months and
Prednisolone 5mg increased to 20mg for 2 months.

1 month
PTA

(+) uterine contractions

ODA

Gyne History
Menarche : 12 years old

Papsmear: Normal

Interval: Irregular- 3months

Coitarche: 28 years old

Duration: 3-5 days

Both Monogamous

Amount: fully soaked

napkins; 3 napkins/day
S/sx: (+) dysmenorrhea

Past medical
history

Family
History

Personal

Social History

Unremarkable

(+) hyperthyroidism- mother

Non-smoker
Non-alcoholic beverage drinker
No known food and drug allergy
Insurance Agent- Dubai

General: (+) FLU (-) weight loss,(-) fever, (-) body weakness
SKIN: (-) rashes, (-) pruritus,
HEENT: (+) blurring of vision (-) redness (-) nasal stuffiness (-) ringing of ears (-) lymphadenopathies
Thorax: (+) cough, (-) dyspnea
Chest: (-) chest tightness (-)palpitations
Abdomen: (-)dysphagia (-) loss of appetite,
)nausea/vomiting, (-) change in bowel movement

(-

Urinary: (-) frequent urination (-) dysuria, hematuria,

Review of Systems

Reproductive: (-) vaginal bleeding (+) spotting, discharges

PVS: (-) bipedal edema, (-)intermittent claudication,
)varicosities

(-

BP:120/70

Temp: 36
OC

CR:

RR:

89 bpm

26 cpm

Physical Examination
FHB- 143
RLQ

Wt= 52kg

Awake, ambulatory, not

in Cardiopulmonary
distress

Ptosis- Right eye,

Strabismus- Right eye,
Anicteric sclerae, Pinkish
conjunctiva, CRT<2secs

Adynamic Precordium,
No murmurs

Symmetric chest
expansion, Clear breath
sounds

Full peripheral pulses,

No edema

1-2cm
Soft
posteriorly located
50% effaced
Intact BOW
Cephalic
Station -2

L1: Breech
L2 : Fetal back at the R
Fetal small parts at the L
L3: Unengaged
L4: Cephalic