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Name:
, and twice a
month onwards until now. She had undergone MGTT at 15 weeks of pregnancy
due to advance maternal age and strong family history of DM. She was told to
have Gestational Diabetes Mellitus. Blood sugar was 5.4mmol/L before and the 2
hour post-prandial blood sugar was 8.4mmol/L. She was on diet control and did a
blood sugar profile. The result of the blood sugar profile came out normal and so
the doctor told her to keep on diet control. Otherwise she has no other antenatal
complications. Her blood group is B+
D) Past obstetric history
She is a grand multiparous woman and is currently G7P6. No history of
preeclampsia in previous pregnancies, recurrent miscarriage, babies born with
congenital anomalies, intrauterine growth restriction and intrauterine fetal
death.
Year
Antenatal
complicati
on
Term?
(37w42w)
Normal/
Baby
Postpartu
Breastfeed
Contracepti
instrument
weight
m
complicati
ing
ve
Until
No
1995
No
Yes
al/
c-section
SVD
1998
No
Yes
SVD
No
6mths
Until
No
No
6mths
Not
No
No
Abruptio
2001
Placenta
No
Yes
SVD
3.25
No
breastfed
Until
2008
No
Yes
SVD
3.13
No
6mths
Until
No
No
6mths
Until
No
No
Yes
SVD
2.95
2000
2011
PREM
3.30
on
No
SVD
1.00
3.27
6mths
2015
GDM
No
All were term babies and was delivered through spontaneous vaginal delivery.
However, she had a preterm delivery of her 3 rd child at 30 weeks, weighing at
only 1kg. She had abruption of placenta during her 3 rd pregnancy and at 30
weeks of pregnancy; she had severe abdominal pain and was brought to the
emergency department. She was given IM Dexamethasone, tocolytic agent and
labor was induced. Baby came out still in the amniotic sac and spent 4 months
in the neonatal intensive care unit and then 6 months of recurrent admissions to
the pediatric intensive care unit. Now she is a healthy 15 years old with no
health problem and is doing well in school.
G)
H)
Family history
There is a strong family history of diabetes mellitus and hypertension.
I)
Allergies
No drug or food allergy
J)
Social history
This is her 1st pregnancy from her 2nd union. Husband is 33 years old and is
contractor. She runs a frozen food and scarf business. Family income is good.
From the business alone she earns around RM4000 per month. Ex-husband also
gives money for other children monthly. No consanguinity.
General Examination :
Patient alert and conscious, wearing hospital attire with medium-sized body
build lying supine on hospital bed. She has long hair with fair skin colour. She was
well not in any distress. She was cooperative throughout history taking and
examination.
Vital signs:
BP
125/80 mmHG
PR
RR
Temp :
37 degree celcius
Differential Diagnoses:
Discussion
concern about decreased fetal movement warrants assessment even if the situation
does not comply with the previously stated definition of DFM.
If there is a history of DFM and viability is confirmed on Doppler auscultation,
a CTG should be performed and referral to hospital is indicated if patient came from
a primary care setting and immediate admission to ward if they came to a hospital.
If CTG is not available in the primary care setting, a woman with a history consistent
with DFM should be referred to hospital for a CTG. If the fetal heart is not heard on
Doppler auscultation, an urgent hospital referral and ultrasound should take priority.
70% of pregnancies with a single episode of DFM go on to be healthy
pregnancies. Women who have normal investigations and resumed movements
following a presentation and history suspicious for DFM should always be
reassessed if they experience repeat episodes. Representation for DFM should
prompt review for predisposing factors, examination, CTG and an ultrasound. Early
delivery is an option for DFM that may be considered in particular situations, when
the risks to the mother and baby have been weighed up appropriately