Page -

History taking

1. Patients particulars
Name Address
Religion
Occupation Marital status
Age
Sex Education Date of ad mission

2• Chief complaint
Duration

3: History of present illness

Type
Radiate

Aggravating and relieving factors

• Course of treatment in hospital

voles child malt

5• History of present pregnancy

O ist trimesten
¢ Nausea , vomiting
g PV bleeding PV
g- Radiation exposure history drug exposure
g- A bor tioD
g: Antenatal investigation
by UPT, USG
g• canfirmed pregnancy
discharg_, breast discomfort burning micturition , pain abdomen
@ TORCH VORL
(Congenital syphilis)
Hb, Blued sugar
Blood grouping : plaklet
Thyroid abnormalities
urine routine examination
 Page -

History taking

1. Patients particulars
Name Address
Religion
Occupation Marital status
Age
Sex Education Date of ad mission

2• Chief complaint
Duration

3: History of present illness

Type
Radiate

Aggravating and relieving factors

• Course of treatment in hospital

voles child malt

5• History of present pregnancy

O ist trimesten
¢ Nausea , vomiting
g PV bleeding PV
g- Radiation exposure history drug exposure
g- A bor tioD
g: Antenatal investigation
by UPT, USG
g• canfirmed pregnancy
discharg_, breast discomfort burning micturition , pain abdomen
@ TORCH VORL
(Congenital syphilis)
Hb, Blued sugar
Blood grouping : plaklet
Thyroid abnormalities
urine routine examination
2こふo Adeq4ak feFal movemiDt： more than 10 KiKSin 2 hours
あ

Folc acd starhed レ mo hth phior to conaeption till 3 manth

22品 es sg) （Hり

少 cndirmed prghany.
02nad trimesto FHS, palpato n,0S
of abdomen8 pelvs
14guickuning(武証tal movmtnt) ett at)
9・Hnde ivo0,fth 改d supphement ザ not?
9 Tetanusdiphthwia Vaccinegian 町 not ? R-22 Nw
か

Q:spial san ⾎ detect any fetal abnorm alites dnr_町 nt・（⽌h mont)
. Deaotming tabletLalbandazalb)taken a nat2
4Anysign ⽌f huadache, blatigg of vision,4plgastic pain ?
Q. Athing of palns and sols Lsign o cholestas
19 Bined sgan iust笹 (E
net aften con⼭umption of alucse（24-28
9:四 ltaka
9-Ptdal edema⼀(地』uk) -⼀
9⼭S年 Nuch al translcene measures nuchal fald thicknass (area of tissut at buck
9uodnplLtedt
. Notmally TesS than るmm
on un born baby's neChk)
(1のwek） 必stな nist for Donn yrdrNg

@237d trimg,
22stt

9.Adequiate fetal moZement pIceived a nat2

Q. Anysign of headache burting of viston2
9・
Thingo 2alm and soles
g- hlwedingPy dischargeA hakage
9-Autning micuntion
19 Iron」（alc/um Continyed ar nat?
9・Tr daAs Td vaLcine ?
0Us年 ね dtuct_plaunta abnor maliteamniotic fuid
(GonoihsCah)
L,wa t)

g.Teal syiijaney
4- Tbtal ANC vsits
 Fetal movement pontvie
1s- 20 welks Cother
16- 20 weeks (other prignane
At hmusten mirontitor as pregnancg)
demand of ironis less
2 days
Menstrual history 4 days
g. Age of menarche ,d_ 13 wik
g. Duration of cycle it weom 2 days
g. Days of flow.no
of pads required
Menstrual cycle ngular or 26 wek
g. Increased flon and irgulat
clot 34 waks 4 days
g. Dysmenorrhea
Td vaccine 2 doses in st
pregnancy
dose in furthe
?. obstetric
pregnancy withi
5 gears
history
9. Married for hon many 22 doses in pregnancy more than
dears ?
5
years
pregnancy
Io. EDD POG

Living child
obstetric index :
Abortion

No of prignancy past
ansspregnancies that
Fiability period (2.28 weaks)

contraceptive histiy

. Past obstetric
history
. Dak and jestation
of deliveny
g. Made of delivery (trreeps, vacuum )
(sponta nenus Linduced Lopenative vaginal or
9 Singleton we muttipls _ prognanuits cs)
g-Any pregnancy compliatin
during 14 nd ard
9: leight and sex of baby NICu trimesten. . postpartum complicattion
administration .
 bieeding in pt trimıste a bortioh, eetopi pregnaney implant tion bieeding.
d ttiemeste molar pregn an c
O5
Dale
fà trimeste ante partum haemorrhage , labor pain, Vae

cerv cal polye, vaginal ma s

g-Health at birth
- Made of int ant feeding

(Contraception history :Cyck disturbanc

b- Past medicalLsurgical history

Family histary
taining
Parents ibings Conzeniłal a bnermalitie s

12, Pesonalhistery bone| habit

ee
diet
house
3 ocib-Lonomit, histery anitary practilee
SourL At drinking natir
9: prug and allengy historye
drug intake

15: Summary
16 Provislonal diagnoi

Na4sA, vamiting caued by inczA B-hcą

 S sis aphui shott stature:L 142 cm

Examination

On general examination,.patient i . lying comfort ably on bed with lycannula on

0f hand

– Colouř of cab ula

she i ell oxiented to timea lace_and person
She has l builtmanne

She is o sciouC0-operativ.

Weig ht
Height
BMI

sin Thyth
Vitzls
regularlyregulan
Pul Q be ał pe minute, o mal in volume and character,
n ,_tadióradial delay,all pui phtal pulses an palpable tak on LAa
emperatut meas ure din. (ideal in rectal

abdome
mucasa) mouuth arm
eevaton , depreston
bre athe Lmin
Respiratory rate12-
Bldod preSsure mm g mtasured in IEatm
0, satuation :

(ardinaL gn▇ ED
tallot(aband in Jos6 palpzblt conjux tiva ,dorsal surfaut of tenguLbucal muLo
anal mu osacase of palms, saltof footicapillary refil time
L Ictenus yella▇ discol rahonobseIved in bubar conjunctiva ▇ nțral
palms olesa of to gutnail bed
Gprad of
chibin C Clubbing(Lowi band angle, śchmreth trianglt) outeas etot lip
gtgs(tp sÉ nnc,peEal ia,a hbue sgen. t e i a
L Lymphaden pathy innelaspect of up e cenra
muEsus membrane of palak ,thel
 ANC visits 12, 20, 26, 30, 34 , 36, 38, 0

2 m aba and pas te rior to me dial malleoli

absvt ankie ngion patholg ital
E = egioh p hys i o l a g i t a ) in pry narey
E fdama (n spink_poaitin in sazal. pmmanttya g. bdamen,Eae)
Da Dehydratin (thseIved in yyl, skin, tnguL(ed butty sateà)l)

Per abdominal examination:

(teYu Sof ttenden. onta e bo▇ ▇

rest l ex í m e t e

Thyrold eXaminanon hitting tinge leXo▇

BreAsk eXaminatibn

Chaadteristisot_puls
Rat Rhythm, YalyneEors,eáien Character Radio radial dilay
Radiotsmoral delay+periphural puls apex_pulse deticit
Sła bi,(a ng .

roximal bl Ck

Mlddlee XAmine

Diłaa

Syskemit eXxaminahn

1a 1piratey LV pe abdaminal thynid brLast

lean_patitnt sLaphtidabdom n.
obuSt vaidg Itbulan
paitien t umbilious
 Investigations during _pregnancy
(A
utineinvŁstigations

Blood Hbhematoait, AB0. Rh grouping. ▇ done

Blood glucose, antibady sEmening

0 rine▇ ▇ ▇ cel

0(eIvical yytaieg Study by Papanicalan ta

Nlasalba kdetictíon st

(B) Specialin estigations

stolagicaltests fot rubeilla,hapatikis B vitus andHI .

(6 lt1ASaund examination
First iriamkter scan eithtr via transabdomin al LTAŠ) er trans vaginal
thelps to detect
-earlypregnan y acEurate dał number of fituseS

-gras5s fetal anom alies

 show: Expulsion of cenvical mucus plug mixed with blud.

Full cervix dilatation (10cm) Date..

Page--------

True labor pain False labos pain

Uterine contraction at regular Irregulan

linter val inter mittent pain)

Frequency of contraction increases Unchang

gradually

Intensity and durahon increases. Unchange

Associated with shon: Not associated

Dilatatron of (ervix: No dilaton

Pain felt In lower back Pain confined to lower abdomen.

radiating to lower abdomen

abruptio placenta
Dilatation of cenvix. concealed

Dilation a deliven of baby.

Delivery of baby Deliveny of placanta

 minimu ANC visits place wight gain (1 )

ANC visits.
9months 2nd 6 3rd
4, 6,8,

Presenting case of Mis- shueta karki,z2 years resident of

Sailahi_, Hindu by religion ,studied upto secondary level, student
by occupation was admitted to Cmc OPD on 2 8th MangsiL, 2019
with clo amenorrhea for months•

Amenurhea fer 9 months

Pain at Lscs site

History of present illness

2 My patient at 14013) mecks of gestation was admitted to
2079
on 28th Mangsit
maternity ward after she pre sented with grossing of
her EDD by 3 days: She has pain at Lscs site, mhich is not
radiating and is aga relieved by taking analgesics:
ourse of treatment in hospital
she is case of past-operative day
she gave birth to single living male child thruugh cs.adeighing
2900 am •hi Hen baby i admitted_to NICU due fo increase heant bea.

History of present pregmany

st trimester

2 She confirmed hen pregnanty by UPT at home.

History of mild nausea and vomiting

a Na history of butning micturition , Pv bleeding . radiation exposure.
She is unden folic acid supplementation.

Dating scan
History of teratogenic drugs
excessive weight gain may quse pre-eclampsia
Total iron requirement a 1000 m9 (6 mg Iday)
Iron (omg given as only
10•% absor bed •
in and mi mester Page
nausea and vomiting
]so fron givenin gna mimester

and trimesten.

pigressive enlargement of abdomen.1l4

9
She perceived hen 1st fetal movement at 20 weeks•

She bad taken de moor ming tablet , iron and calcium.

41h and 5th month.
she is vaccinated with Tetanus, diphtheria vaccine ( 2 doses)
No
history of head ache , blurring vision .epigastric paib. 14

No itching of palms and soles: (18-22)

Special scan to detect any fetal abnormalities dona at 20 meeks and is said
to be normal.
(24- 28 Weaks)
2 Blood sugar test done afren consumption of glucose and is said to be murma

3rd trimester .

Amenorrhea continued nith progressive enlargement of abdomen 444

she penceived adequate fetal movements.
No history of headache , blurring of vision itthing palms and soles.
No history of PV leakag No pain abdomen
Iron and calcium continued.

Menstrual
history
My patient attained her menarche at age of 16 years .
a Hon syde is mgular(281 ?)days , bleeding lasted for s days nse 3-4 pads a day-
Dysmenorthea is present
 done fus 20 min)
of fetal cardiac activity)
(elechonic movement

Obstetric history
?
Married for 1 years

LMP - 11th Falgun , 2078

Mangsit _2072

Contraceptive history
She doesnt use any contraceptive methods

Past medical I surgical history

No history of diabetes ,HTN ,asthma, thyroid disorders . mi
No any surgical history
sho
Thene is history of
having renal stone for 6 yeau fu which
taking medicine

Family history
No family history of high blood prossure_, diabetes asthma, IB.

thyroid disordens:

Personal history
she is non-smoker ,non-alcoholic, and has mixed diet..
Bonel and bladden habit normal

Normal sleep sycle.

Socio economic history

she lives in well ventilated house with proper sanitant prachce.
Dry and allergy histery
No. history of kn n alergyt any drugs o substar till dale
Summany
22 yeay sld female. at ( ot 3) e ksot gestation _preSented to
1( T DP
 sphygm omanomete ideal cuff size1
hsusiet ona
Hypotho mid hy Perthearmią valu c?

kadial puls brachialsuhclavan (anatid puls fmraL ykse

tbial puls da s alis _pedis
Pul

BP taken in supint Lsitting positien in tttnsht brachial aitety

Tmpeat ure * measured in

'o9 *.
 Condition whee height of uterus is

polyhydramnios , big baby ovarian DY fibrord tymols, H.molq

condition where height of uterus is less Dale

nin, fetal arwth
mistaken date of LMP, scanty liquor am Page
10 fetal death.

Fetat Fundal_ height_

Above symphysis pubis at 12 weeks gestation

At umbilicus at 24_ Weeks"

At xiphisternum at 36 weeks.
Equidistant from symphysis pubis and umbilicus at 16 week •

Equidistant from the xiphisternum and umbilicus it is about 30 weeks

Inspection Palpation Auscultation

-Striae gravidarum
Linea migra
Scars Presentation : breech , head
Fatall movements Attitude

Lovel of presenting part

Fetal movements

Liquor volume.
 32
yau
ech e
Satwdaym anin
+2 leve Admit ted

coain abdo men

butring mictuaibe eetpii preonany

Yamp
hot breohi t

pain at incision sile.

fovo. taday
a Hangu
LMPl(2s t$) day

12 ye.
dysmunorhe is
12 ye
pughte (9 ye) Vacr mVD.
3. g ghandt y h spit )
Da un drce
▇DIt )
3 motith injectia. Dng
E ouy pils

fut mdial Isg hstngt

 g. No-of pads soaked par tial / full.

Page

Presenting a Case
of Mrs: Mina magai 32 years old, heading from
Bhanatpu1-10 completed hen secondary level, teacher by occupation admitted
to
pain at incision site

Chief complaint
Pain at lowen abdomen

Burning micturition Pain at Incision site

Historyg of present ill pess

My patient was apparently well
2 days back until she suddenly develop.
cramping pain in lowen abdomen According to hen. pain was cramping." not radiating
to any othen site aggravated on walking and retieved brr associated with

shotness of breath, fever (maximum recarded tempi not associated with cough . calf kende r
L ap anato my•
She is case of and
post-oporative day following emergency,surgeay as she is
diagnosed with ectopic preg nancy Now she complains of
she received Packs of blood
(N9 associated with breast tenderners,
Menstrual history
My patient attained he menarche at
age of 12 gears without clot,
Hen period is fegular (3015)days bleeding lasted for_ 4-5 days ,.changes
2-3 pads a day
Dysmenorthea is present
Blood test, USG. done which revealed
ruptuned,
Obstetric history ectupic pregnancy fus Ahich she has gonk
Married for 12 gears thnugh laparotony She is on hen 2nd
MangsiL, 2019 post- operative day

0•1:
 Dato

Amis ą La

9 yrs . M nysir 2 h ER
th
Mangsi.
Hetą uudg

Ho k t LL 12 ea

yvunitnog ain obdonsr. video X-rag us▇ nght va ▇ vyot:

day opoetm
ow bdomel. ind ha ham (3 0tve).

ain d tncisin
No

se mi olid.

19ye
( 8 $S) day day,2 f clot

Dysmeronhea
e
1 (gn)(1o day)
NOTMal Handa haupik , 3, brest lading ( s y)
uk emb go (obuin)

epnoT Ml .
p r -—
Noalle*
Pranila Daalam
a, Batsh :Ł Htucmakelugs (*
bah.—

/3,20 S/ oP? B 2days te

pain a inciston sile emeency
Ayga valai byary mo e Dens—
ANC visits, boked case of (M(
CI
R

Mona che = a y No
Cyeke regula , daurclot dygmenon he.
Y
pad s
ried for ye
0
wt:22 g feml , Cs (dut to pe- c lmp), lact gen.—

W thy e dis rde (hyo) diab etu ;hynid disode

Tap Not .
pink colow .
No alle y LHP= 2th chairg-
Dae o4.
wah0
st trimete :
vPT a hahQ .
Iron d r ast".
GCT,
head aacho .
UsG
ven vomihng*—
fili q d
 dull aching. pain spasmodic parn ( kidney stone, merse)
shal p shooting pain
thro bbin a parh in abs( e1s), migraina)

history
Presenting a ease of 1&• Pramila Parlami, 28 years old, resident of
bharatpur - 1, die completed hen MBBS degree, doctor Py occupation, hindu
by religion, married presented ito CMCTH OPD with clo pain at incision site
on Ast Poush , 2019.

pain at incision site .

History of present illness .

started lavg
Md patient was apparently fell 1 day back unti she developec sevire
headache which was acute o onsat, not rerdia not assiated hith othen

My patient presented to CMC 0PD for regular ANC checkup mhen she
was diagnosed to have high blood pressure for which she was admitted for

of admission
2 days And after o days she bight through Lsss.
she had history of mild headache but no history of blurring of vision,

( plannea)
She is case of 310 past openative day following elective Cs with outcome
of single live female child weighing 2200 am, baby seems to be healthy and
is with her mother formula feeding:

at incision site hich is mild not

Now she complains of pain radiating to

a ther site , aggravated by any movements and relieved by taking analgesits and
doing rest .
Thert-is-no history of PV bleeding PV Leakage
she is booked case of CMC TH and is on regular ANC visits:
 past- operative infechio.
breast emporgement ,thrmbophlebihs, UTI, respirata
wound infection. Date

History of present pregnancy

st trimesten

-she Confirmed hen pregnancy with the help of urine pregnancy

test kit at homer and alse done

She had moderate mausea and

) she had no history of burning micturition, parn abdomen,
PV bleeding _ PV discharge ,no broust discomfoxt
9
No radiation
expos ure history
2 No history of exposure to any teratogenic drugs.
she is under folic acid supplementation.

2nd trimester .
Ame northea continued with progressive entargement of abdomen
; She perceived her st fetal movement at 20 meeks

she had taken deworming tablets and vaccinated with Id

special scan to detect any fetal abnormalities done and is
sard to be normal-

2 ND history of head ache , blurring vision epigasthic pain

No itching of palms and soles : pedal edem a
No burning micturition, PV bleeding M leakag.
Bload sugan tatbe done
water is sard to
atto adminitratin of gluose and
normal.

A And visits are regulat:

trimester

a Amenorrhea continyed with

progressive enlargument_ of abdono
a she perceive adequate fetal movement•

History of mild he ad che

Iron and calcium continued but na blurring of vision _ pigut hil pa,
 If volume is less , equivalent 7
h menshuaf bleed, color is

"hysterechmy 7150 m.2 35 u 3 d

clinically pak , tachycandia, hypovblemia

No itching of palms and soles

No Pv leakage
weight gain in pregnancy is 12 kg_

Menstruall
history
a she attained hen menarche at age of 13 years
_ Hen sycle is regular (.28.1.5 days), bleeding lasted for 4-6 days, with
fe n clot changis 3:4 pads a day; which was paatially soaked:
obstetarc history
-
She is married for + years , primigravida

EDD : 35d Magh, 2039 (Nagele's formula).

P0G:3513) weeks.
Chil d description :

Contraceptive history
She doesn't use
any contraceptive methods.

Past medical and surgical histry.

? She is patient of hyputhyrordism history of
high BP sune last 1 month
and is unden medrahim
No
any surgical history.

Family history
 Date
Pagp.

PeSonal histo1y
Sht deunt use any tobacco and alcohol_products, till dak:
Bo elhabit i ormaL, o bladd complath

ocio-eConomic histany
Patient
practces
ives in l v e n t i l a d hause nith prope sani t aay

Drup and alle Y histaty

N history of alleg t any medication dust , feed lldak.
Und o úron nda cal um Supplemenłatum
 th
Puja Thapa. op9 .. Menarche - L3 years
Kawasooh, 2, years
ANd visits.
3 days
Pain 1a boul

Not mnal delivery, episiotory:

Son, 3300 9m., pretermn LuP - 2-5th Chaita, 20 78
heathy. 1.5 month, Magh &1d 12019
kit at home PO Gr = (36+1) weak.

9th
Mpe Thynn dism sina

Pain at peline um his

6¾ - SS filtered wate

Presenting a history of Mrs • Puja Thapa , 23 years ald, mamied heading fom
kawasnoti, completed hen secondary level education , hindu by religion, presented
1 C MCTH maternity ward on sth Poush, 2019 with clo labor pain:

History of present illneat

shys back until she
My patient as asymptomatic suddenly develop
pain in lowen abdomen ahich was radiating to innen aspect: of thigh and not
relevd by enedication and rest.
She is case of 1't post partum day following vaginal deliveny associated
with episiotomy mith outcome of single Jive male child weighin g 2800 gm,
affen biy th , seems to be healthy and is with moth en.

She is booked case of CMCTH: which was mild

Now she complains of pain at perineum, wthich was not radiating and relieved by
gaking medication
Menstrual hishry
Sht attained he menarche at ageof 13 yeàu
Hessycltis regulan C28 2)d ays, le dinglastel tot ▇ ▇
pith_clatChanges _pad a day
wyathea
obstetc hist gm 10day
MaLlied for
yean p r i m g av i d . = m
LM 25th chaita20

EDD: 2nd Magh 2039

Po( (3 t ) ek
0 P
Conbace pł t history She doen't ust any onbauphivt m tthod
Past medital and surgica history sinc th s ła to
she s dgoud sth bgnsthynidium daint tuik dnani.
No
any surgicalhistory

(Eamity hishry
No
histi oftbih 9thyroid disordeLdiabetes ,asthm, T

Drug histoiy
Na history of alengy to any medication tilL date
folic acid taken.

Iron and calc um *

 Toly histey: N Tma) ne

filteed wak r.
feuonal hietog: Bo e) nane)
aonuna)
Blodd na Mal.
No aile8
non = ve Cm bata ption hisiny
ama Adhka Teach cope -T.
No side effecd
32 ya . Masted's danr
Hetaudg. th Poh.

labe pai n , matenity wat

Nbl nal de liveny pisiotomy.
d itv bleding in-mens,
Gth p g h prpn.

Jl:53 am,
mild pain :
daughte , 3
UP T at hohe ,3 yea▇
Bhosap haspital
( monih)
mild naw omitng edical of Hetquda
b eat disComtort —

foliC acid

ladiaton xposw▇
Age of merarche =l u y
Nlo toanogenit duys agula ést)
2ng 4 mdnths 5 days -3 peds , no co.
DysIero1h (t)
In Caldium

Td (2 do s ).
bsttn
pe 0 mir hot doreę ,
oye I .
Ahomaly fan manth, WMP* Chaiba 12 20
Gardom Biood syga kst due,ngmd), poh. 19 ,20 9.
gP , No
o a| AN v / s
loky
 In case of J Fetal movement, admitted D AN fom oP D •
and soles My patient
Ask about itching of palms several invubgato done 8 is sard to he
24 hrs.
only penceived fetal movements in T
§ soles•
NO histog of Pv leakage, Pv bleeding. itching palms

Presenting a history of
MTs: Rama Adhikani_, 32 years old , married.
heading from Hetauda , teachen b
completed _hen master degree, teachen by
occupation presented to MCTH maternity ward on ath Poush , 2079•
she is an unbooked cased of CMCTH.

c/o

Pain at perineum_

History of present illness

in usua stak of hen heatth
She was
apparently healthy 23hrs back bifore dning vaginal deliveny
following episiotomy and
now she complains of sharp pain at incsron site
which was sudden on on set
aggravated by movements and
relieved by rest:
Thes is na fiver. head ach&, burning micturition vomiting. dizziness
She is case of 23rd post partum hour
folloving vaginal deliveny wtth
episio to my with an outcome of single live female
child xeighng 3 Kg. baby
cried immediately atten birth and stems to be healthy and is with muthen.
History of present pregnancy
1st trimester

a She confirmed
hen pregnancy with the help of unine
home at 1.5 months of hen last LMP2
pregnancy test kit at

she had modenate nausea and

vomiting
No history of burning
micturition. pain abdomen PV bttedhe leakag
Thene is
history of breast discomfort
9

She is unden
folis aud supplementation .
 Hypen pyrexia

Page

and
Ame norr heq continued with progressive entargement of abdomn
She perceived hen first fetal movement at 96 weeks (4 m)

Deworming not done

Two doses of Td vaccine

> Under iron and calcium supplementatio

No history of headache blurring of vision, epigastris pain, burning
micturition , Pv bleeding
a Special scan to defect any fetal abnormalities done at S month
(20 wok) and is sard to be harmal

9 Nohis try of itching"palms and sole

5 Blood sugaa tust done and is said to be normal.
No pedal edema ANd visits done

Amenohea continued with pmgressive enlargement of a bdona,

Iron , calcium continued

hood athe , burring of, vison, hcadache. Pv blecding, tchicy.al

of
and

Menstrual history
- Age of menarche = 14 gears

9 Hen cycle is regular (2815) days. . bleeding Jasted for s days.

not associated with clat , changes 2-3 pads a day.
Dysmenor hea is present
Obstetric history
Mannied for 10 gear.
LMP : chailra 12,2079 0I: P,L2
EDD : Poush 19, 2099

P0 G: 381L) week .

She gave birth. to single living male child through vaginal deliven y at

Bharat pur hospital ,weighing about_

Baby is alive and well fully immunized.

Contraceptive hishry
a She use copper- tr as temporany contraceptive method

Past medical and surgical histiny

 Date
Page.

Examination

General examinaho

a Patient is lying comfortably on bed with .v r annula on dorsum of

hand

a colour of
cannula : green
a she is well oriented to time, place and penson.
9 She has well built manner

a she is conscious, co-openative.

weight s
Height
BMI:

vital sign.
Pulse : 87 beats I minute, normal
in volume and characton, no
radit r adial delay-
Tempen atur e :
Respiratory rate breath I min .

Blood pressure • mmlha measured in RIF ann.

Cardinal sign
 Budgha laxmi Sth 3LyeaM , Bharnat pu -3, shop, sie
t poush. OPD
ED0 5=
pain gbaomn buckpain. Pouh
buded a Hb
pšatmy 5 moh thamovt ment pen ▇
Pan at peineu m
relieved by mediatim ot ) b

— UPT at hom - us dur (*h Ba)

J e vomitms4 tómuten ; ithing palos end lu 120/ m m
Folit acd . g.
Tnn cala m v tH h Fatyun
And maly scan (nr mal)
ot zgin:
V anula :nee
.
(Tdong.

De Nomt

Me ye .,S days /

be
reyulal, 2-3 pads ;no dot dyane nerheg ( m|.

obsthn ( neln -vy

Kea.
4 ye
HP: th Fa gune s al gy
n 1nd daugh 28 gm
Ghild3 1 ", 3e
Norinelhaspiha).
na me, ąch gen. ( day).
cmtaczphive hit Pat me al sugi al
No
 ound soekoge SST.
Dale
hge.
B loody diiha,

Muih Kumal18yeus J ł pul 1l cae

▇ oPD,

gth
po vh ru ry
0
Błond tve
Shaeeo hasi
Lses
CHC deli veny refenred
Preon p Mn AN(v i
vPT at home . (2 modhs)
Amamaly san(-).Bined sugal
holiaad. - not dorę
No e
t D l owi k
plyóamtiss Em S( fr
LMP, Y chaa
eDD :Po h 2 th
An hyram Do with P2sM akay
ith pupe ap at▇

Tm CW
dayhte ( o togo)
brat feding 8B bea / m n

hye of menaich - y
( Nays, 2-3 days, t , days
Dsmeno he.

Mannied dt yet .— No u

ixed die.
 Resuturng cas

Prstnting a histo ry of Munal kumal, years.mamed heading from

jet puLStudied up higheSecondary schon hausLnift by mcupation,
hindu by tligión presented CMCTH PDon stha Poysh20 9 ith CLo

bleeding tom sutur site

She unbied eas

H opI

was in he usual siekof hea t day back henthe nohrel soakage of

atnd (on he gth po) , e ddis h in co ia ohich che p ented to (MC -H OPD
h e Rsyhaing as don e.
sh P
No she mplaihsof pain at sture site which was sudden on onset ▇
by mevemants and relievned by aralgesic.
Thee is no tve PV bleeding headache breast engrg ement, bwaning mit ha'ha
Hishiy of present pregnany
st
imeste .

Lancmed pregnany with help of UPT at homeat 2 menths of henLHP -—

( nd hrimeste-—

Amanenhea Contnued w th pgasvR_Rnlagenunt:f abdv ah

She_perceived hen 1st feral movement atsh snths (20 wec ).
Na buaning michathm , ehiosof pal ▇ and soa, headacht blu ming of Wis,
gurc _pain WV bleeding
Special scan detect fetal abna malhes vöaS hot don e.
Grlucose challenge tut not dn t
Regu al ANC visilDrwaming doN, Tao deus of Td vaccin
- Imon und Caluum supementah' o
 zed h mest

a Ire0 Caltíum' contnued.

un mingemet thámia
ot.

hae i nhahgyef y bleeding hudacheblutring ▇ vision

epigas ric pain .
itc hingo palms l s es
heue histiyt▇ isn ▇ yin eda ls
olorles not associated oith bloo d and is eneug t soak he undelgauned
anal, bed sheet -—

Menstrual hisbry=
Age at menarche = 3 yeau
Hen pen iod is regulag (28 s) days bleeding lasted fe da , not
Ssociated ithclt changes 2 pad ▇
Nlo hishry dysmenorrhea .e

obsteti c his hoy

Mar/ed fer yean
P,

P:▇ ahre20 ▇ 8 )

EDp 2sth Puugh ,2 e

Po(:

(in hatphve hish Sht diurt e any tn baughen .

 Date
Page.

6 minatton

Patient is lying tomfortably on bed kith iv cannul a of rs um ot vight hand

Colour ot cannul
la is re n
She is we oriented to time place and penson 1gi

She ha e)lbuilt manhe

She is Conscibus o-op▇
wt Ht= D/ J

Vizls

Puls B& bpm inormalin volum Chaaacten_and naradioradial delay.

Íempeatu measWed in am piłs

Respíraty rak
Blnd preSure

CandinaL sign
palloricteu tyanasis, ynmphadanapathy dehydrat D
Dbs ved
 ER cNC TH.
Mam: Devi Bumjan yeae Lautahat, heusai k, +2
. thPoush,J0: ▇ ▇
Anhydvam nils,
Pam ( ron site, shap,
Daog h te, 2 5 gw,
, mpnth U h
Na Us0 , voo ttng
Folit acid ( ) b1egt dis(omost—
Sum3 lr

a moVemen mo nh

Swlen h and e
gs
T (t dn), 1 nn
AN glar ( mamaly scan d one baby is
dd , h ma De

s of menar che 4 yeare

Ragu laa 3 days,

Manied fo 1yea
1-2 pad paRaly soaked, no clot, dysme noorheo,
Tksevic ird

Ne (onłnac phVe hit y.

LMP= 2 9/02/L6
ND sug y, Np meical EDD = 20 9|oS 19/ 3
No taniy histay
R
mixed dt, smok , al ohol (x)
B e|

aU aley
 Dale
Page -

Presenting a thistory of Mrs: Devi Bomjan..28 yeans old, manied heading

from Rautahat, housenife by ocupahon, completed upto- hen highen secondary
level education , presented tD CMCTH ER on ath Poush 2079 3

¢/D : Pain at incision site

History of present illness

My patient nas in hen usual state ofuhealth

fut PR OM WHA 3 day back until she t044
had gone through emengency LsCS following oligohydramnins with
she complains of sharp pain at sutun sike which was sudd in on
 16 9T 20 22 28.)
decreases

Duga Ragmi Adhikani,33ys, Bhalatpul.

hotel, bachelor completed . OP D

Pain at incision site , spasmodit pain Corected LMP =2019112/14

No Rover 24th Poush
ANC visits , boked case
204 baby. son (313) blus,

Poush 29th,2078 baby, UsCs,

Not
1031lo2 ,3 days. pads, No dysmenorrhea, no dot
1st tim aster

Is months
No flit ao'd.

Anomaly sour dore quickening

pedal dema.
done .

Age at menarche = 20 K9
Married fur

Contraceptive : undom .

Hypothyroidism .
 Date _
Page-

Presenting a history of Mis Durga Regmi Adhikari 3.3 yeons old. mamried heading
from Bharatpuq . business wam en by Dctupattion , completed hen bachelor degree
presented to CMCTH DPD on 9th Poush , 2079 . she is booked case of CMc.

chief complaint pain_ at incision

History of present illness .

My patient was apparently well 2 days back until she had gone through.

Now she complains of pain at incision site which was sharp, insidious on
onset , not radiating, aggravated by movements and relieved by rest .
There is no fever, headache, buaning mictunition frequency breast engorgement•
She is 2nd day post-openative following LSCs (Lowen segment caesenian sectim)
with an putcome of single living male child weighing 319 baby czied immediakely
aften birth and seems to be healthy and is at visiby's sde.

History of present pregnancy

2 She ctmpleted h confirmed hen pregnancy through USGr at CMCTH
she had nauseq and vomiting.
2 No historg of burning muturition, frequenty , pain abdomen, PY leakage,
breast dswmfort , Pv leakage.
2 No folic acid supplementanim

No history of exposure tn radiation ,turatgenic drugs

2nd rimet n.

Amenatthta ontinued th pgressivnlagehentt atxhmeh.

fitst fetaL movement perceived at 16 e s( mr s)

De Atming net dene.

Unde iron and olitacid supplementatin
Tion doses of Td vaccine aken.
Ne histty t burming micturitan. htadache.blurring of vislanepggast
pain ithing of palms and 0 e a ka g e
th
pecialscanto detect any fetal abnormali ties done ▇ month and

isSald to be normal.

Bloed suga2 tust dene atte consumptian of gluGSeand is aid he

ormale

Pedal edema present

ANCvisit done

zd trimeste.

AmenortheataLomeVconti
aAdeguate nued with przressivL enlargement of abda meh,
eme nt peceIved
Tron. alcium ontinyed

Ne histagyat htadache, luntingt visiniepigastaic_painithingt

palms and so es PV bleeding

Mansttualhistry
t menarche 2ayea
Headaysycla itegula2,▇ asłed ▇ ▇sed pad
Dyame rthea_ahs -
 Date 1
Pag

Obstettic._history
aMannied r o yea
8 m

LMP: 1 th chaiha, 20ł8 do

EDD:2yth Poush,20 9
P ( (8t1) eok

She gave_bicth single lving male child thraugh elective SC▇

Ne palgunj hospital eighing about 32oogm a—
Baby is alive and wellfully immunized

Cantauptive histor
ate

Past medical and surgicalhistry

Shei sutfering trom hypothyroidism sincL 4 yearS-—
history of high blead pressure thyroid disordeS,asthmaTuberculasis
ND anysurgtal his tory

Famiy histuy
No histey of high B,thynid disord ens, sthma_Tuberulasi
Hes metheris hypenkensi e patient*=

Pesonal his ha
Nøn -Smoke,de ent drnk aluhoL, has mixed ditt NDmal bo el lee yc .
ell ven lated house with open sani tary prachce.
Secioeconomiç hishry: livu in
Diz and alleyy his hry Nalhishry
dak
of allezy t any medicahen , to d, ubstøncu
Examinaton.

Patitnt ygingaamfartablyion bed with L cannula on right hand

(alour of an ulablue
She i loriented timepla and _peYsOh
She has w ellbuitmahne
She i conscious o- penative

Vinls

Pulse Ł2 beats pe minuk

 Date
Page-

Presenting a hist or y of Mis: Indira Kumari Ramauli , 32 years old, married

heading fram sarlahi, housenife by occupation_, Completed hen highen secondary
level education
presented to (MCTH emergency on 10th Poush 2079 :

she is referred fom Sanlabi hospital .

0/0 : Pain at incision site .

History of present illness

My patient was 'in her usual state of hen health 4 days back until she
had undon? Lond si ment Caesanian section ap she was diagnosed with
pregnancy induced hypent ension
Now she complains of pain at incision site mhich nas sharp, insidious on onset.
not radiating aggravated by movements and relieved by rest.
There is no fever , headache , burning micturition frequency .breast engorgemenb
She is on hen 4th post -operative
day following emergency LsLS with
an outcome of single. living male child neighing 3:5k9 .baby cried immediakely
aften birth and seems to be healthy and is at visitor's sido

History of present preghanty

1st timesten

she confirmed her pregnancy with help of OPT kit at home

She had nausea and vomiting fix which she had taken medr cation
2 No history of burning mict urition . frequenty + pain abdomen, PV leakage, breaub.
discomfut.

Folic acrd taken .

No history if expo sure to any radiation, tehratu genic drugs.

 nd trimaste
Amenunheacantinued aih prgressivL enlarzgenent ot abdamtA,
firsttatalmoment_penceived at 5 menths:(20 Reeks)
DeuDrming dane
Inden iron and folic acid uppleme ntatm.
Io drses of Td vaccine taken
aNe_histary of buming mictutitt headachebluring of viston.
pigashric_painiłchingo_palms and es
fchal e a ka s
pecial SCan.to
detect anyabnor malit done otth month and
is said t be ormal
)
Bloed ugartest dune( afte consumption of glucose andi ▇ ▇
ormal. 4D mgldL nomal)

( Pedaledema _present
ANGvÍsi 1egula

rd ttimesten
Amenm hea continued aith prgrac eehlargemet of abomee
Adeg ak detalmoVeme ntp AceIved
Iron, aldium Contin ed

Nn hishay ot headacheblurring
itthingof palmshd a es.
of visian episas hni_pain buthing bunbu
hee i histry
ot leakage h i c h ▇ i
uderlesscolaorlessahichenough oakbecloth ▇ n c o ns i t ł e n e y
and bed.sheal

Mensttualhishry
Agef menaachs year
mn
He
a ui pha trya a 1dag*Sotful)
 Date

Page.

obstetric

Married for 5 years:

chaiha, 20 18 .
1ath Poush ,2022 ..

she gave birth to single living male child weighing 3:5 kg which is normal
and is breast
feeding

Contraceptive his tory the doesn't use any contaceptiveg

fast medical /surgical history• No history of high B2, thynid disordens, asthma, 14.

thyroid disordens, asthma, I& in heu tamilg.

Ab history of high Bl,chid
There is history of twins" of her sister.

These is no congenital anomalies history

Personal his tory a No thistory She is non-smoken and doesn't

she has mixed diet _ Normal bowel habit_. sleep (ycle

in well
socio- economic hishry =) Lives ventilated house with propon sanitany
practice.

Drugs and allengy hishory

E No
hishrg ofallegy to any medications m funds
til dale.
 t poh
S ) ana hyal_ y Bhanatpw 12 ch hoWseik. o sf (M n.
CS gth 3
13 o h 26s
19a

Pain tincismsk ▇ fom ▇

gvated by move ment nokeve ,head acht, IV daachw . V bleedirg
n buo ed Ca

ANC , eclą mpsą , i

uMP: 19th chaib .
Aa of me raache 13▇
EDD', 2t poush
f day. 2-3 pads , partrally o ked) n0 cts
done
dys menúrthe ( -).
U ine He4t, Blood test done.
uPT d hame Masred fo

No Yadiah m e pswe.e 6 e
No Folic acrd
Son, 4 g4 lactrgen , narmel t vista's sidę
In , calcr um done No conhraception wed .
d
20/h
Gu kening
Ta vacthe done (2 dose) h morth. Ns mediCal and sugital histoy
DeBriing duna .— fathe and Hothen (H TN)
lacha ,blwoairgof vkion epac Bnthe (suga)
bts /mit
No heada
Ciaurd
Amsndy san done. otehing palmt and col (.)
(T diN, ugan(), ne medrcahen daę - No aleyg hishey
oGTT test
at dint, sigat(t)ANG syulae
Ne V luakyg. V bleedig)
 Hy Porension - geaziness, sghcpe

Pregnancy induced hypentension

Presenting a history of Mrse Srijana Aryal, 29 years old, married, hesident

of Shatatpu , houst soik by occupatop, studied upto _highen secondary level, hindu
by religion , presented to CMCTH OPP on lith Poush,2019-
she is an unbooked case of CMCI

c/o: pain at Incision site. fu a days

History of present illness

ANd check when she was
My patient presented to CMCTH DPD for regular
dlagn sed to have high blood pressure for mhich she mas. admitted and em.

Lscs was dene. atter.

ow, she complains of pain at incision site, which is sharp, insidious on onset_
not radiating totver, site aggravated
otherheadache, by movements and relieved by meticaho.
buanirs michniton frequency, breast ngorg e ment
There isono
she is on hen 3 post-operative day following emeigency LSCS. with an

outcome of single living male child weighing 1 kg. seems to be healthy, is

visitor's side and undon formula feeding

History of present pregnancy

st trimester

5 she confirmed her pregnancy with help of urine Pregnanty Jest kit at home

a she had nausea

and vomiting
N history of burning micturition frequency pain abdomen , PV leakage
breast discomfort.

Folic acid not taken.

to any radiation : teratogenic drugs

No nistory of exposure
 Date

Page

2nd trimester .

2 Amenorrhea continued nith prD gressive enlargement of abdomen.

a she penceived hen ist fetal movement at 20th week.

Den orming done

calcium
Unden iron and folie actct supplementahon
2 Two doses of
Id vaccine taken ane month apoat4
No
history of burning micturition_, headache ,blurring of vision,
epigastric pain . itching of palms and soles , Pv Leakage .
Special scan to detect any fetal abnormalities done at sth month
and is sald to be normal.

Blood sugar test done after consumption of glucse (50gm) and is_
said to have diabetes be abnormal for whth she didn't take any
medication

ANC visits regular

trimesten

Amenorr hea continued pith progressive enlargement of a bdomen.

Adequate fetal movement penceivea

Iron and calcium continued.

of burning
9
No history micturition, itching of palms and soles-

Age.of menarche = 13 years

HOL cycle is regulali lestee: bleeding lasted fu 4 days, uses 23 pads day
pads pautial'y soaked, ne clot present , dys menor hea absent.
• Obstetric history
2 Married
fur 6 years
1 9thChaitra, 2018 01: PLLy

EDD. : 26th chaitra, 2079

she give birth to single living male child weighing 4 kg which is.
normal
and is unde fur mula fuading
No ory modes of
Contraceptive history - ste deesn't use ang conhraceptives: by both the partners.

Past medical and surgical hismry -2 No history of high BP thyroid dwardey,

asthma, Tp.

Family hishry Hen fathen and mothen have high BP:

Hen brother is diabetic patient_

Pensonal history Sheis non-smoken. doesn't dFink alcohol.

she has mixed diet: Normal banel habit_, sleep cycle, no
bladden_ complain

Socin-economic history2 she lives in ioell ventilated _house woith propen sanitan g

and. allengy history 2 No histry of allengy th any medication. fond til dale.
? Unden iron and calcium supplemenaton

Examination
bed
Patient is lying comfattably on
is well oriented to time place and penson.
she has mell built mannel.
shris conscious and @openative.
Patient

Dale
ag

(S

a RulstL80 beats Lminute regulatly regular sinus thythm normal

in voL ume
characten, o_radi1adildelayall periphea)
pulst are_palpabl taken_oh ghtradtalarteny

Bloodpressue 30/8O mm
of Hgtaken on xight brachiaLar y

Temp atu

Ałoy ralale :—
Respira
*at

(ardinal n. rolymph nadpule b

The re
s ne sign of pailotLictenu l u b i n g ya d ymph hadeno pathy
edema , dehydratton
 Mis op st/ snyin pnmi

sorg in muih

Dudl Ale, 2yees raindakk, hole wike, , oPD yn besoked Cas , DM

v ne test,FHS, Us—
LHP: thChaibr ▇ 2078 4/S m pn/k - sugal dekcted .
EDD: 22rd Pough, 20 9 m
op
inak:uP home . a 15 month fom lHP w
(-) li acvd 34

buning mitutihm ,
mont guickening
Adeguett tetal moe me id
feł.—

Im , alci/um( )
, bo m
Td (+)
Deing ( ) Mhunze at menancht :18you. 3- days ineguae
1homaly scan-)
i( ),2 peds. dyonahea(+).
(, sugoa deraPcodj a iMaonied t 3 es- A,

HoPL A
conina8phve
NaFathe: (+)
bistary
do
1yea befoe manth abu m
Baseline fetal heant rak

Dacel atton, Accelenati on „Beat beat variability.

 n, 이 C*
Dao,
ia 0 Pag-

Chandm Sunuw 32 gta 4 Blatat pa-16, h a t lk. 3 dass

18th Poush 079 labar pain 해yntwaed
shon cT
Pain 따 incision site, shaap pain bodmmen pain
buded ca *
t mn at : UPT at hom oft 15 month.n i
folrt a id (-) , na e vomitrg. teralgenic 6)
2Minaka: Deu ming done, Ta()
( 8'
tehy talns atnd sla.
iry 따t gth mortk.
Quickenin
()bimwon,
1gas (
haadache,
in( ~),

3 혐 tn astt , Ade uak fetal move me nt Anonely so n doe

ND b arning mictuai htsn, feq nay mttunt1o (-
Hnstual histny: Age of mehaache 3 yaa
사 16 irregulaa 7 mon hs ap
( ny, pas, Fuly soaked ,ho clo ,
obslehic. Maor ie h 3y▇
: 2/2S/2078 S Mond h,
61:
on , 2o yea , 36 , vagihal d lvey, Ghop0, Comp
,

son, 2 yeh ad,3:6g vihl dlivoy, (MC,

Conta phve▇ don.

Past / meditd histny: No )

세mily his tny Nst pusmt
po ral hi longy m ed▇
 urine pass befase abdominal eominahm? a full bladen can cause

symphysis fundal height taken (in cm.

abdominal
examination Abdominal airthtaken at level of
um bilitus (in inches)
Obske mic grisp

# Methods of obstetncal examination

Abdominal examination

After
2& weeks of pregnancy
¾ Diagnose lie, presentation , position and the attitude of fatus.

Preliminaries

Patient is asked to evacuate the bladder.

Made to lie in dorsal position with thighs slightly flexed.

Inspection
(inverted)
> abdominal shape ,position of umbilicus, scar mank.
incisional scar mark.

Lina nigra Cfrom umbilicus to pubis), striae gravidarum (s4)

(blackish broian)
(iffct of eshogen oth collageD
increases it's
superficial local 4 in
Clauhicity leads
Palpation temperature
local tendernes
Fundal height tenderness
9 use the ulnar borden of left hand

rss and mys donnoard. when resistance feels it oill inditate fundus.
Symphysis fundal height (SFH)
2nd resistand
a fetal pole.
 cT (candiotpgpraph) dect het rak.
i Dale
Page.
he (

Us p Amt

hundal htğht , at 1l weeks in gmphyss pubis L) CrLBPD4 C

AC, F
16weeksbetneen umbilicus and S

29 weekS at umbilicus
U G n 2nd t muk
30 eek bl umbilicusand xiphiste um
place tą laatnr anomaly an,
36De txiphištenum.
mnioh tl d voym

Obste tnic ipleapaid maneU ▇ ▇

Typa
(flexton of e relax abdomeh muscle)
0 Fun
ndal p
_lalpation is done facing pahent's face
Palman aspect of othhands ▇ aced on fundus t find out hich pole
affttus ying in tht fundus:
broad_ aftand ieegular mas.sugges byech
ball oa b e . tofef .
smoath, hard and gla bular mads suggests head
„No feal poles _palpałed bransve lie;=

Latenal Lumbilical g ip
Deneby fating_patent's face, using both handt
Pal patt lateral aspect of the umblics ,keeping ane hand steady and
using anather hand t palpakand repeat procesE on both aide
Locakthe backlimbs_and anenur shoulder-
emphy itegu|a knobfike
sm oth curvegl
|ory g.resšqnł
Fee

(Iett |at U al)

 cooss pelvic brim. lor entred the pelvis
Biponietal diameten

24th week us fundal height corresponds with PoG. Page

face patient's face +-only ong band used_

Palpak by keeping unan burden of right hand at symphysis pubis

thumb and two tingens)
and grasp the presentahim_
9 To identify presentation , descent , engagement
ballotment (+) - No engagment
ballot ment (-)
= Engagemen

Pelvic grip
Done facing pahent's feet, buth hand used.
four fingers of both hands are placed on the either side of
midline in lowen pole of utenus or parallel to inguinal ligament

palpate presentafim _ presenting pant , engagement.

Abdominal girth

a Measurement of distance
around the abdomen at specific point
often at
level of belly button.

On
inspection ,abdomen is
shape , umbilicus it centally placed.
inverted lovented . No dilated vessels •

All quadrant of
abdomen are moving equally with nupiration
nigra is present
striae gravidarum present more. twand flank region.
No presence of:
All hennial orifices are
intact on cough reflex.
 )

fetal movementnot dete cted

in abruptita_placenta Limmatune sepanaten of placen a) o bes mothe,

oyhydramnio anten i'orlo anton ofplacentta dakt why Iu FD

oligohydramnios

0lisohydrammins
amnioh fluid 200 nL at m
AF 1 5 cm-—

C
Fetal chromoS omal or shructural anomalie.
Renal gene▇ ▇
SpontaneDus rupture of mem bran.
Post m at nity I GR.
Amnion nodo sum (fail ure of secretíon by the
ctlls of the a mnion cevening the
p)a ta-

Mat enal conditions:Hypentensive disordes uteopla n

de hyat at en.
tol ihsutfci enty

(om ) cah on
Rtal: Abutti on 1 deførmity due b intra -amniohc adhesFons, tad com presS/ oh.
hizh fetal matalty
Meenal Prolonged labor dut inetia.
 Dale

Vago.

Polyhydramnibs
Amnioti flud

AF I 24cm

alargest ventital pocket 2 Rem

Caus .

ftłul anomalitsAneIcephaly
focial lefts
pen spina bifidaesophageal atresià,
and neck masseshydrops fet alis.
Placent a: Choribangioma of l centa ▇
A

Multiple regnacymorecommon in menozygotısins

MatermnalDiabee

rais ed maternal bloed ugaL raised

hydr amhio 6
fttal bl o od sugalp
ittal diures=
 Bishop score

6-13 , unfovorabe 2 0-5

fetal head

Cailatetion. effacament Consiskmcy position)

Induction of labor ( IbL) utenthe contractions by any methed for purpose of
vaginal delivery:

Purpose of IDL Whin the risks of continuation of pregnancy eithen to the mothes
or the fetus is more inducton is indicaled

Elective induction of Labor initiation of labor at term pregnanty witbout

any accaptable medical or sostem indirahu.

Indications for IOL pre-eclampsia, eclampsra, maternal medical complicatis_

( DN, chinic renal disease)
post maturity, abruptio placanta
IVGR , PROM , TUED, oligelpolyhydiambias

contraindications for IDL

Contracted pelvis_, mal presentation C bruch. transvense)
previous is ,heant disease , unbilital ord prolagse
Hi soprashol ts given
Factors for successful induction of labor.
the post term. dase of 25 M9
vaginally eveRy
Bishop score 2.6 : positive mytocin sensitivity test
 It is a composite graphical record of labor events (matennal and fetall entered

against time on a single sheet of papen.

of mother and tetus
used to monitr progrus of labounl and sailent conditions
Components of pontngraph
0 Patient identification nang, obstetrical score, gestational weeks, date of
admission, consultant name

Time recorded at
hourly interval: zero time for spontaneous labor is the fime
the time of
admission in the labor ward and for induced labor
i'S
of

induction.

Fetal heart rale 9

recorded even y 30 min, mentioned it by dok and join these by liner

'T if membrane is intact.

State of membranes and color of liquot 2 mar k
Color of ampiohyt fluid clean ' c'

meconium stained liquor

Cer vical dilatation plat cavical dilatatron m.cm [Plotx] or decent of head

§ decent of head (plot o_

utenine contrasfion._ mentioned in squares of vertical column in a 1o minute

interval and fill. it according to intensity or duration of
contraction

220 sec of tantractions Mild

20 - 40 sec. of contractions. Modenak.

 G- N
m Awed 4h opart not more tha day
y tolic 3o mm Hg 1
diastli * S mm g1. L2,20 y,26,36,30,, 4 o
Gamplication duting t trimesten
Akortian (sopitv bleeding+.Jain abdhmen)
Ectapicp ancymalar pregnancy eSS VAmitins

Camplication during ndtimestus.

pregnancy induced HIN. precLampsia

rstatenaldiabetuUII mbo rtron. hiLbith

Lomplicatton duting timeste

APH,pr-eclampsia

Anlenałalinveahgation for 19omen in laboL

Bload grouping (blandransfusion, incompatbilily
in (ase of Rh -—

CBC(RBC la es
seolegy(HV, HR-sg.vDRL H )
ine roytine exominattom ( ru l out UTı)
ired
US (fetal seight, fetal presentatten amni otic fluid volum placenta location.
fetal (ad isbpgraphy
Abruphtio placntą im matul sepaahm of placantą - ,

EetalmaVement Ounk
(6Candit "'(aunt 10 fotm uą1
Shaat at sa m ana s ppe n 0 m vementt perteive,
IceSsive (
fetal mavemeo s during

0 Daily fttal movement count (DEM)-

t counksx eachat one haur dutation (morningnoentvening)
htal counks muitiplied by tour gives daly 12 heur let l meYtmnia

CauSe ofAPH
Placenta previa placn m abrphm

(huu ą ddo mina

Cause of
päin duning3 mestes
aboulUII.

Impattanct of usG in sttrimesto:

pregnanigcntematen taitingu hpi_peznaney fela) haat srnd.
malat gna y▇ txad Jak ▇ ( ▇ scae).
 Plac na prev'a plaunta completely or parhially covus thc eni gof ut (T ▇
(mplantah
risk factos lo fibrór'd on of fer liz ed e 0.
, mu)típan y

Colotof amniotis tlud Condihohs

breech pr sentatioo.
G en Colour (meconium staíned) 0 Wm htd
olden (du bilirubin) Rh incompatibiltty
Dark colored ConCealed hemerhage
eenish yellc astim aturity
D rkbro Up.

#Pr eclam psią ▇ al HINwith proteinuri *

J.
BP 14o / o mm H afF 20 wks of prznanc
f days ho ap
Diagrosti critenía fot pre-eclampsia
HIA, Edamą,Prteinula: C20:agm Lh)
Riskfacho foo pre-eclampsta

Px migravid 4, famil y his try0besi ty placental abnatmalit —

Etilpathalazica)factars for pre eclampsta

vasuulas endathelial damage intlammataty mediator ,coggulation abnmgl

PiL-eclampsiahen cormplicaled ath generalized tonit cloniLonvulsions And

r (oma is called eclarmps(

HN multisystem diśard of unkno in etology chana ctevzed by dex |øpmnd

fHTN to extent of 14 / mm H r mre afte 20th wee in previously
Tua mdkns ive 0 mn.
Ri of 20 mm MAP
 Hypothen mig-a below 36C(95"F) Impostance of hypothermiq, hy pathenmiq.

Date
Page

# Recommended cuff sizes:

40%• of orm tagth
80 %% of ann bugath.
Adults (by arm circumference)

Patients Recommended cuff size

22 to 26 cm 12x 22 cm (small adult)

2 to 34 cm 16x 30 cm (adult)
35 to 44 cm
16x 36 cm Clarge adult)
45 t0 52 cm
16 X 42 cm (adult_ thigh)

Children (by age)

New born and premature infants

Infants

older 9X 18 cm

Recommended tutf sizes

Width of
kor tokoff sounds inflatable bladder
upper ar m
circumferene.
012-14cm)
Phase
Tapping sound
tength of inflatable bladder
Phase
soft swishing sound 801 of uppen arm circumtrence
Phase 3
crisp sound Lloud knocking
phase 4
blowing sound L muffle
Phase 5
silence
 Td helps to deerease

Low lying placenta 2cm foom cewvix.

Placenta previa at covix

grade of clubbing

Grade 1 - Nail bed fluctuation Dehydration tapes

Grade 2 Obliteration of lovibond angle (Toss of wate
Grade 3 parrot beak ing drum stick_ Isotonic (Toss of wateland
Grade 4. hypentrophic osteoarthropathy
of the
( syndrome characterized by clubbing of digits , periostitis
Jong bohes and anthrihs)

Grading of Edama.

Grade 1t 2 2mm depression , barely detectable

immediate rebound

Grade 2: 4mm deep pit

A few seconds to re bound.

(prade 3t 5mm deep pit

10-12 seconds to rebound

Grade 41 weny deep pit

20 seconds to rebound

Lauses of edema in pregnancy

physrological (due to 1 venous pressure of the inferior extremiter
by gravid uterus pressing on common illat verne.

_ Anemia and hypop rokine min.

condias foilure.

_ Nephrotic syndnm
 (Cumplication of pust part m pP ,s harthes it breath, intectron
( ,uppen espiratoy) Datn
Van0.

Non obstt n't (aus Obstetzitause

acid eptiLdiseasee Miscauiag
) īI Ectopic prgnancy
appendicitis terineLupture

pancYeattis Pr -ecatm psi aa

La bo
Acute-hepatitis

Pregnancy induced HIN

yshlic(7 |4 mm
Ho D1 shlio
20 weks afte gestation
4 hrs apart not more th an day

gravd utenus comprus IVC

spine HTN Du s preload Ivenous pooling
I zyndmme

Thoraco abdominal Abdo minal tharac.

sually seen in female and ch Usually Seen in male
In female escent. of diaphragm Durng t spiration ,diaphragn
resisted by abdorminal visce1a descends that pushes abdorminal)
Theefore there i increased moVement visceradto ardthere fore
of xib cage that intreas4s thoracilu mtaz ibdomthal w || is raiSed.
abdomi nal moVe ment
tharacic m Nement_prominent pn min ent .

Prygnad lady
 (
Past op rative fever causeS
Inftction (uIl reispiratory) breast engargement,thrombophebitis
post partum PV bleeding
> PPH Lofa.
( blo cloSS 7

( inia V:D> 500 m.

Past S hystunectomy 1S00 m.

Clinically pale, tachycardia, bypavelemi a

Lochia uteine dischageoccurs aftes borth

blood volumeequivalent to mtnshual blcnd

Lochia Yubyą t tageTochra TS daE ved in ▇ (a▇ 3= y

Type
Lochią se0s ą 2nd stage lochia is pinkich in color . ( -10 ys)
lothia al ba Thi rd age Tochíia iS whihsh yelow in colourt12 day
3 oks)

Lochia rubra (onst.ofbluad ▇ otfetal membraned sid uaulanuga and,

Lechia 1 As a ▇ otJuS RBCbut more katyh ▇ , 0bund me coni yh,
mucUs fnm cevix and minurganis Is =
Lechi4 alba cantains_pknty af decidual cell ,leukacytmucuKLshalestnn
uystaliL stty and granular Lpithial cellt and m apariSnN —
 (
Past op rative fever causeS
Inftction (uIl reispiratory) breast engargement,thrombophebitis
post partum PV bleeding
> PPH Lofa.
( blo cloSS 7

( inia V:D> 500 m.

Past S hystunectomy 1S00 m.

Clinically pale, tachycardia, bypavelemi a

Lochia uteine dischageoccurs aftes borth

blood volumeequivalent to mtnshual blcnd

Lochia Yubyą t tageTochra TS daE ved in ▇ (a▇ 3= y

Type
Lochią se0s ą 2nd stage lochia is pinkich in color . ( -10 ys)
lothia al ba Thi rd age Tochíia iS whihsh yelow in colourt12 day
3 oks)

Lochia rubra (onst.ofbluad ▇ otfetal membraned sid uaulanuga and,

Lechia 1 As a ▇ otJuS RBCbut more katyh ▇ , 0bund me coni yh,
mucUs fnm cevix and minurganis Is =
Lechi4 alba cantains_pknty af decidual cell ,leukacytmucuKLshalestnn
uystaliL stty and granular Lpithial cellt and m apariSnN —
 (
Past op rative fever causeS
Inftction (uIl reispiratory) breast engargement,thrombophebitis
post partum PV bleeding
> PPH Lofa.
( blo cloSS 7

( inia V:D> 500 m.

Past S hystunectomy 1S00 m.

Clinically pale, tachycardia, bypavelemi a

Lochia uteine dischageoccurs aftes borth

blood volumeequivalent to mtnshual blcnd

Lochia Yubyą t tageTochra TS daE ved in ▇ (a▇ 3= y

Type
Lochią se0s ą 2nd stage lochia is pinkich in color . ( -10 ys)
lothia al ba Thi rd age Tochíia iS whihsh yelow in colourt12 day
3 oks)

Lochia rubra (onst.ofbluad ▇ otfetal membraned sid uaulanuga and,

Lechia 1 As a ▇ otJuS RBCbut more katyh ▇ , 0bund me coni yh,
mucUs fnm cevix and minurganis Is =
Lechi4 alba cantains_pknty af decidual cell ,leukacytmucuKLshalestnn
uystaliL stty and granular Lpithial cellt and m apariSnN —