CASE OF ANAEMIA IN PREGNANCY INTRODUCTION As a part of my specialty subject requirements I was posted in corporation maternity hospital, Banashankari. When I was posted in antenatal Ward I have taken Mrs. Vasanthamma for antenatal assessment. She was diagnosed with Anaemia and she was very cooperative with me and gave me all the necessary information BASELINE INFORMATION Name - Vasanthamma Age - 30 years Occupation ~ Housewife Husband’S Name ~~ Bailanjappa Age - 35 years Occupation ~ Coolie Address -Nelamangala Income - Rs.3300/month Religion -Hindu SE Status - Upper Lower class Obstetric score -GsP2L2comes with 8 months of amenorrhea DIAGNOSIS - ANAEMIA DURING PREGNANCY PRESENTING COMPLAINTS - Easy fatigability since 2 months HISTORY OF PRESENTING COMPLAINTS: + Patient presents with 8 months of amenorrhea with easy fatigability since 2 months. Previously, the patient was able to do her household work, but for the past 2 months, she gets tired even with minimal work. On walking about 50 m, patient complains of fatigability, giddiness, blurring of vision which is relived on rest.+ No history of increased bleeding during menses prior to pregnancy. + No history of exertional dyspnea, palpitation, PND, pedal edema or giddiness. + No history of bleeding or leak PV. + No history of bleeding PR or malena. + No history of passing worms in the stools. + No history of fever with chills and burning micturation. + No history of cough with expectoration, hemoptysis, evening rise of temperature or contact with a known case of tuberculosis. + No history of drug intake (anti-malarial drugs or aspirin). + No history of any yellowish discoloration of skin and sclera. + Nota known diabetic or hypertensive. OBSTETRIC HISTORY: Married Life ~ 13 years, Non-consanguinous Obstetric index - GsP2L2 LMP - 02/11/2011 EDD - 09/07/2012 BABY AT PRESENT No DELIVERY | BIRTH AGE COMMENTS Booked & Cried soon Immunized(Had after birth, 3 ANC visits + TT FTND, Male, 3.2 + IFA)Post Government kg, Breast 12 years partum period - G —_ Hospital fed 3 years normal Baby cried Booked & soon after Immunized(Had birth, Female, 3 ANC visits + TT FIND, 3 kg, Breast + IFA)Post Government fed-2% 10 years partum period ~ G2 Hospital years normalPRESENT PREGNANCY + No history of nausea, vomiting or weakness. + Nourinary symptoms + No drug intake + No history of craving for abnormal food (pica) Te + Quickening in 5% month + 1*ANC visit - 20 weeks, given TT & IFA tablets (consumed) Ts + Fetal movements present + Noleak or bleed PV + Noh/o pain abdomen CONTRACEPTIVE HISTORY: No history of using any contraceptive methods. MENSTRUAL HISTORY: > Age of Menarche ~ 13 years > Past Cycles ~ Regular 30 days cycles with flow lasting 5 days, normal quantity, no pain or passing of clots. > LMP - 02/11/2011 FAMILY HISTORY: No history of congenital anomalies or twinning, DM, HTN PAST HISTORT’ > No history of Tuberculosis, Epilepsy, Asthma > No history suggestive of any cardiac ailments. > No history of previous surgeries, blood transfusions. PERSONAL HISTORY: Diet ~ Mixed Appetite Good Sleep ~ SoundBowel & Bladder - Regular Habits -Nil DIET HISTORY: Consumes ~ 2100 keal/day Required - 2400 kcal/day Deficit ~ 300 keal/day INVESTIGATIONS: Urine © Albumin absent © Sugar :absent Blood © Hb% 8.4gm% © Grouping Bee e VDRL : non reactive ° HIV : negative © HBSAG :non reactive © RBS : 126mg\dl © Rubella nil GENERAL PHYSICAL EXAMINATION Here is a pregnant lady 30 year old, moderately built and nourished, conscious, alert & cooperative. VITAL SIGNS Pulse - 84/min, regular, good volume BP - 110/68 mm of Hg RR ~ 14/min, regular Temperature — ~ Patient is Afebrile GENERAL EXAMINATION Pallor ~ Present Icterus - AbsentCyanosis — Absent Clubbing — Absent Edema ~ Absent Lymphadenopathy —_- Absent Thyroid - Normal Breasts - Normal Spine ~ Normal ANTROPOMETRIC MEASUREMENTS Height = 146 em Weight - 56 kg BMI 26.27 HEAD TO FOOT EXAMINATION HEAD : Normal HAIR : normal distribution, black in colour SCALP : lear, no dandruff, pedicules absent FACE :normal, cholasma gravidarum present EYES : vision is normal, sclera and conjunctiva normal, Pupils are reactive to light, no discharges, EARS ears are symmetrical, absence of discharges, hearing is normal NOSE : symmetrical, normal septum, no discharges present ORAL CAVITY: normally distributed teeth, absence of dental carries, absence of halitosis, tongue is coated NECK : normal range of motion of neck, Absence of lymph node enlargement, Absence of thyroid enlargement CHEST : symmetrical expansion of chest, scar not present, Operation scar not present BREAST & NIPPLES: slightly enlarged, there is slight white discharge From Nipple and nipple is normal without any Retraction or inversion HEART : Heart rate is normal, 86 beats per min LUNGS : normal and symmetrical chest expansion, Breath sounds are normal, 14 breaths per minuteABDOMEN : normal bowel sounds; constipation present, Ascites absent, operation scar present, abdominal girth is 76cm SKIN : linea niagra present, stria gravid present, Cholasma gravid arum present EXTRIMITIES : upper and lower extremities have normal Range of motion, slight edema in the lower leg SYSTEMIC EXAMINATION CVS -$1S2 heard, No murmurs. RS - NVBS heard no basal crepts. CNS - NAD. PA ~-Normal bowel sounds heard OBSTETRIC EXAMINATION INSPECTION: + Abdomen is uniformly distended, globular in shape + Umbilicus everted, hernial orifices normal + Flanks do not appear to be full + Stria gravidarum and linea nigra present + No scars over the abdomen PALPATION: + Abdominal circumference ~ 76 cm + Symphysio-fundal height - 28 cm (corresponds to 32 weeks) + FUNDALGRIP - Soft, broad & non-ballotable, suggestive of breech + LATERAL GRIP > Knob like structures on the right side suggestive of limb buds > Uniform resistance on the left side suggestive of spine + 15" PELVIC GRIP - Smooth, hard, ballotable mass suggestive of head + 2" PELVIC GRIP - Fingers converge, head not engaged. + Uterus is relaxed + Fetal age = 28*8/7 = 32 weeks + Fetal weight = (28-12)*155 = 2480 gm AUSCULTATION:+ Fetal Heart sounds heard along the left spino-umbilical line + 142/min, regular, rhythmic