Preoperative diagnosis:
G1P0 Pregnancy uterine 41 weeks age of
gestation by early ultrasound, cephalic, in
labor; bronchial asthma - mild intermittent,
not in acute exacerbation; dysfunctional la-
bor (prolonged deceleration phase, failure
of descent) secondary to cephalopelvic
disproportion at the inlet level
Patient came in for induction of labor.
Medical history:
Patient was diagnosed with bronchial asthma since childhood
and was maintained on Salbutamol 2-3 puffs per day as
needed for dyspnea. Last asthma attack was noted at 20 weeks
age of gestation.
Prenatal History:
First prenatal check-up was done at 16 weeks age of gestation
with regular visits thereafter. At 24 weeks age of gestation, 75
grams OGTT was normal. At 40 weeks age of gestation, bio-
physical profile showed intrauterine pregnancy, live, singleton,
cephalic in presentation; adequate amniotic fluid volume (AFI
17.8 cm DVP 5 cm); placenta posterior, high lying; and sono-
graphic estimated fetal weight (3231 grams) is appropriate for
gestational age; biophysical profile score of 8/8. No other ma-
ternal illness or BP elevation noted. Total weight gain was 35
lbs, ideally 25-35 lbs.
History of Present Illness:
Two hours prior to admission, the patient had onset of intermit-
tent crampy hypogastric pain radiating to the lumbar area with a
pain score 8/10, not associated with bloody or watery vaginal
discharge. Patient sought consultation and was subsequently
admitted.
On admission:
BP 120/80 mmHg HR 94 bpm RR 18 cpm Temp 36.60C
Ht. 152 cm Wt. 68kgs BMI 22 kg/m2 (Normal)
Abdomen: Gravid, FH: 33cm EFW: 3.26 kgs (7lbs, 3oz)
IE: 2 cm, 50% effaced, station -3, medium, posterior, intact bag
of water, cephalic, Bishop score 3
CTG Category I
UC: 6-7 minutes, 60-90 seconds, FHT 140 bpm, MVU 105
Cervical ripening with evening primrose oil 4 capsules was
started.
Clinical Pelvimetry:
Diagonal conjugate: 10 cm
Sacral promontory palpable
6H: IE: 4 cm, 60% effaced, station -3, medium, midposition, in-
tact bag of water, cephalic, Bishop score 6
CTG Category 1
UC 5-6 minutes, 60-90 seconds, FHT 145 bpm, MVU 90
Oxytocin drip was started.
10H: Spontaneous rupture of membranes, clear amniotic fluid
IE: 9 cm, 90% effaced, station -1, ruptured bag of water,
cephalic
CTG Category I
UC: 2-3 minutes, 60-90 seconds, FHT 145 bpm, MVU 340,
Temp 37.3C
12H: IE: 9 cm, 90% effaced, station -1, ruptured bag of water,
cephalic
CTG Category I
UC: 2-3 minutes, 60-90 seconds, FHT 140 bpm, MVU 300,
Temp 36.9C
13H: IE: 9 cm, 90% effaced, station -1, ruptured bag of water,
cephalic
CTG Category I

Preoperative diagnosis:
G1P0 Pregnancy uterine 39 6/7 weeks
age of gestation by last menstrual
period,cephalic, in labor;dysfunctional la-
bor (prolonged deceleration phase, failure
of descent) secondary to cephalopelvic
disproportion at the inlet level
UC: 2-3 minutes, 40-60 seconds, FHT 145 bpm, MVU 300,
Temp 36.9˚C
Patient came in for watery vaginal discharge for 1 hour
Prenatal History:
First prenatal check-up was done at 12 weeks age of gestation
with regular visits thereafter. At 24 weeks age of gestation, 75g
OGTT was normal. No blood pressure elevation was noted
throughout the pregnancy. Total weight gain was 33 lbs, ideally
25-35 lbs.
History of Present Illness:
One hour prior to admission, the patient noted watery vaginal
discharge, non brownish in color and non-foul smelling, associ-
ated with crampy hypogastric pain, radiating to the back, with a
pain score of 7/10. Patient has no complaints of bloody vaginal
discharge. Patient sought consult and was subsequently admit-
ted.
On admission:
BP 120/70 mmHg HR 90 bpm RR 18 cpm Temp
36.6 C
0
Ht: 149 cm Wt: 60 kg BMI: 20 kg/m2 (NormalI)
Abdomen: gravid FH: 32 cm EFW: 2.95 kgs (6lbs 8oz)
Speculum exam: (+) pooling with thickly meconium stained am-
niotic fluid
IE: 4cm, 70% effaced, station -3, ruptured, cephalic, soft, mid-
position, Bishop score 7
CTG Category 1
UC: 3-5 minutes, 30-50 seconds, MVU 300 FHT: 130 bpm
Antibiotics started
Clinical Pelvimetry:
Diagonal conjugate: 10.5 cm
Sacral promontory palpable
4H IE: 6 cm, 80% effaced, station -3, ruptured bag of water,
cephalic
CTG Category I
UC: 2-3 minutes, 40-60 seconds, FHT 140 bpm, MVU 300,
Temp 36.8C
6H: IE: 9 cm, 90% effaced, station -1, ruptured bag of water,
cephalic
CTG Category 1
UC 2-3 minutes, 50-70 seconds, strong, FHT 130 bpm MVU
300, Temp 36.4C
8H: IE: 9 cm, 90% effaced, station -1, ruptured bag of water,
cephalic
CTG Category 1
UC 2-3 minutes, 40-60 seconds, strong, FHT 145 bpm MVU
300, Temp 36.6C
9H: IE: 9 cm, 90% effaced, station -1, ruptured bag of water,
cephalic
CTG Category 1
UC 2-3 minutes, 50-60 seconds, strong, FHT 140 bpm, Temp
36.5C
Preoperative diagnosis: Patient came in for watery vaginal discharge for 30 minutes.
G1P0 Pregnancy uterine 39 6/7 weeks
age of gestation by last menstrual period, Prenatal History:
cephalic, in labor; obese class I; dysfunc- First prenatal check-up was done at 12 weeks age of gestation
tional labor (prolonged deceleration phase, with regular visits thereafter. Aspirin 100 mg/tablet 1 tablet once
failure of descent) secondary to a day was started. On initial visit, and at 24 weeks age of gesta-
cephalopelvic disproportion at the inlet tion, 75 grams OGTT was normal. Congenital anomaly scan
level showed no gross congenital anomaly. No other maternal illness
or BP elevation noted. Total weight gain was 20 lbs, ideally 11-
20 lbs.

History of Present Illness:

Thirty minutes prior to admission, the patient noted watery vagi-
nal discharge, clear, foul smelling associated with crampy hy-
pogastric pain radiating to the lumbar area with a pain score of
7/10. Patient sought consultation and was subsequently admit-
ted.

On admission:
BP 120/80 mmHg HR 90 bpm RR 20 cpm Temp 36.6C
Ht. 147 cm Wt. 79 kgs BMI 32.4 kg/m2 (Obese I)
Abdomen: Gravid, FH: 32 cm EFW: 2.9 kgs (6lbs, 8oz)
Speculum exam: (+) pooling, thickly meconium stained amniotic
fluid
IE: 4 cm, 70% effaced, station -3, ruptured bag of water,
cephalic, soft, midposition, Bishop score 7
CTG Category I
UC: 4-5 minutes, 60-90 seconds, FHT 135 bpm, MVU 270,
Temp 36.7C
Antibiotics was started.

Clinical Pelvimetry:
Diagonal conjugate: 10 cm
Sacral promontory palpable

4H: IE: 9 cm, 90% effaced, station -3, ruptured bag of water,
cephalic
CTG Category I
UC: 2-3 minutes, 60-90 seconds, FHT 145 bpm, MVU 340,
Temp 36.9C

6H: IE: 9 cm, 90% effaced, station -3, ruptured bag of water,
cephalic
CTG Category I
UC: 2-3 minutes, 60-90 seconds, FHT 140 bpm, MVU 330,
Temp 37.1C

7H: IE: 9 cm, 90% effaced, station -3, ruptured bag of water,
cephalic
CTG Category I
UC: 2-3 minutes, 60-70 seconds, FHT 135 bpm, MVU 345,
Temp 37.0C
Preoperative Diagnosis:
G1P0 Pregnancy uterine 40 weeks age of
gestation by last menstrual period,
cephalic in labor; myoma uteri, intramural
with subserous component; dysfunctional
labor (prolonged second stage of labor,
failure of descent) secondary to
cephalopelvic disproportion at the inlet
Patient came in due to watery vaginal discharge for 13 hours.
Prenatal history:
First prenatal visit was at 17 weeks age of gestation with regu-
lar visits thereafter. At 17 weeks age of gestation, pelvic ultra-
sound showed intrauterine pregnancy, live, singleton, cephalic
in presentation; adequate amniotic fluid (DPV 3.8 cm); placenta
posterior, high lying; and sonographic estimated fetal weight
(211 grams) is appropriate for gestational age; uterine myoma
(3.7 x 3.4 x 3.0 cm) posterior upper corpus intramural with sub-
serous component (grade 5). Patient was advised to watch out
for signs of abdominal pain, pelvic pressure or vaginal bleeding.
At 24 weeks age of gestation, 75 grams OGTT was normal. At
36 weeks age of gestation, pelvic ultrasound showed intrauter-
ine pregnancy, live, singleton, cephalic in presentation; ade-
quate amniotic fluid (AFI 21.7 cm, DPV 6.7 cm); placenta poste-
rior, high lying; and sonographic estimated fetal weight (2871
grams) is appropriate for gestational age; uterine myoma (2.4 x
2.3 x 1.5 cm) at the anterior lower uterine segment of the my-
ometrium intramural with subserous component (grade 5). No
blood pressure elevation nor other maternal illness was noted.
Total weight gain was 27 lbs, ideally 25-35 lbs.
History of Present Illness:
Twenty five hours prior to admission, the patient noted watery
vaginal discharge, clear, non-foul smelling not associated with
hypogastric pain or bloody vaginal discharge. Patient sought
consultation. Speculum exam and ACTIM Prom were negative.
Patient was advised for a biophysical profile and to come back
with the results.
Twelve hours prior to admission, biophysical profile showed in-
trauterine pregnancy, live, singleton, cephalic in presentation;
oligohydramnios (AFI 5.9 cm DVP 2 cm); placenta posterior,
high lying; and sonographic estimated fetal weight (2720
grams) is appropriate for gestational age; biophysical profile
score of 8/10. The patient still noted watery vaginal discharge,
clear, non-foul smelling now associated with crampy hypogas-
tric pain radiating to the lumbar area with a pain score of 4/10.
Patient was subsequently admitted.
On admission:
BP 120/80 mmHg HR 90 bpm RR 18 cpm Temp 36.5 C 0
Ht. 159 cm Wt 68 kg BMI: 19 kg/m2 (Normal)
Abdomen: gravid, FH: 34 cm EFW: 3.26 kgs (7 lbs 10 oz)
Speculum exam: (-) pooling, Actim PROM was positive
IE: 3 cm, 70% effaced, station -3, ruptured bag of water,
cephalic, medium, posterior, Bishop score 5
CTG Category I
UC: 2-4 minutes, 60-90 seconds, FHT 145 bpm, MVU 300
Antibiotics was started.
Clinical Pelvimetry:
Diagonal conjugate: 10.5 cm
Sacral promontory palpable
4H: IE: 5 cm, 80% effaced, station -3, cephalic, ruptured bag of
water
CTG Category I
UC: 2-3 minutes, 60-90 seconds, FHT 140 bpm, MVU 290,
temp 36.8C
6H: IE: 8 cm , 80% effaced, station -3, cephalic, ruptured bag of
water
CTG Category I
UC: 2-3 minutes, 60-90 seconds, FHT 135 bpm, MVU 280,
temp 37.1C

8H: IE: fully dilated , fully effaced, station -1, cephalic, ruptured
bag of water
CTG Category I
UC: 2-3 minutes, 60-90 seconds, FHT 140 bpm, MVU 300,
temp 36.7C

10H: IE: fully dilated , fully effaced, station -1, cephalic, ruptured
bag of water
CTG Category I
UC: 2-3 minutes, 30-40 seconds, strong, FHT 135 bpm, MVU
300, 36.6C
Preoperative Diagnosis:
G1P0 Pregnancy uterine 36 weeks age of
gestation by last menstrual period, breech
in preterm labor; Preterm prelabor rupture
of membranes x 27 hours; Subclinical hy-
pothyroidism; Gestational Diabetes Melli-
tus – Insulin requiring; Gestational Hyper-
tension; Obese Class II; Nonreassuring fe-
tal heart rate pattern (prolonged decelera-
tions) CTG category II;
Patient came in for watery vaginal discharge.
Prenatal History:
First prenatal visit was at 11 weeks age of gestation, with regu-
lar visits thereafter. Patient had a strong family history of hy-
pothyroidism on the maternal side, an elevated BMI of 30 kg/
m2 with no associated symptoms such as fatigue, insensitivity
to cold, constipation, and muscle pain. Thyroid panel was re-
quested. TSH was elevated at 4.27 uIU/ml, FT4 was at 20.24p-
mol/L and anti-TPO at 0.98 IU/mL. Aspirin 100mg/tab 1 tab OD
PO was started. Patient was referred to IM-Endo service and
was started on Levothyroxine 100mcg OD PO. Thyroid studies
were done every 4 weeks with unremarkable results. At 16
weeks AOG, first BP elevation was noted as high as
140/90mmHg with no associated symptoms and was advised
BP monitoring with a BP range of 120-130/70-90 mmHg. At 25
weeks AOG, congenital anomaly scan was normal. 75 grams
OGTT was also taken which showed elevated fasting blood
sugar of 99 mg/dL. She was advised for capillary blood sugar
monitoring and medical nutrition therapy with fair glycemic con-
trol (acbf 85-100 mg/dL, 2hpp 108-128 mg/dL). At 28 weeks
AOG, strict fetal kick counting was started and was advised for
serial BPS monitoring with a BPS of 10/10 in all scans. No
other maternal illness was noted during the course of preg-
nancy. Total weight gain was 13.6 lbs, ideally 11-20 lbs for pa-
tient’s BMI.
History of Present Illness:
Two hours prior to admission, patient noted onset of watery
vaginal discharge, clear, non-foul smelling, associated with mild
hypogastric pain PS 3/10 non-radiating. There were no associ-
ated symptoms such uterine contractions, dizziness, and
bloody vaginal discharges. Persistence of condition prompted
consult. Thus this admission.
On admission:
BP 140/90 mmHg HR 77 bpm RR 19 cpm Temp 36.5 C 0
Ht: 160 cm Wt: 101.6lbs BMI: 30 kg/m2 (Obese Class II)
HEENT: trachea midline, thyroid gland not palpable, no lymph
nodes palpable, neck veins not engorged
Chest & Lungs: equal chest expansion, clear breath sounds
Abdomen: gravid, FH: 30cm EFW: 2635 kgs
L1- cephalic
L2- fetal parts on the maternal right side, fetal small parts at left
maternal side
L3- Breech
L4- not applicable
SE: (+) pooling
IE: 2cm, 60% -3, ruptured bag of water, fetal sacro-anterior po-
sition, medium, midposition (BS 5)
Admitting CBS: 93 mg/dL
CTG Category I FHT 150 bpm
UC: 1 in 20 mins, 60 seconds, MVU 60, FHT 150 bpm
Dexamethasone 6 mg deep IM, 1st dose given
Antibiotic coverage was started
Preeclampsia panel: normal
6H: no IE done
CTG: NST reactive, FHT 130bpm T 36.5 C 0
BP range: 130/80-90, asymptomatic
Chest and lungs: clear breath sounds
CBS: 134 mg/dL
Preeclampsia panel: Normal
Urine protein:creatinine ratio: Normal
Urinalysis: Normal

12H: no IE done
CTG: NST Reactive, FHT 150 bpm T 36.8 C 0

BP range: 120-130/80-90, asymptomatic

Chest and lungs: clear breath sounds
Dexamethasone 6 mg deep IM, 2nd dose given

18H IE: 3cm, 80% effaced, station -3, ruptured bag of water, fe-
tal sacro-anterior position, soft, midposition (BS: 8)
CTG: Category 1
UC: 1 in 20 mins, 60 seconds, MVU 60, FHT 150 bpm, T 36.5 C 0

BP range: 120-130/80-90, asymptomatic

Chest and lungs: clear breath sounds
CBS: 186 mg/dL
Rapid-acting insulin analogue 2 Units SQ was given

24H: 3cm, 80%, station -3, ruptured bag of water, fetal sacro-
anterior position, soft, midposition (BS: 8)

CTG: Category II Prolonged deceleration noted to as low as 90

bpm from baseline FHT of 130 bpm for 4 minutes and 30 sec-
onds. Resuscitation was done with change in maternal position,
oxygen supplementation, IV hydration, and fetal scalp stimula-
tion. However, the prolonged deceleration recurred from base-
line FHT of 135 bpm down to as low as 70 bpm for 5 minutes.
UC: 5-6 mins, 60-90seconds, T 36.8 C 0

BP range: 120/80, asymptomatic

Chest and lungs: clear breath sounds
CBS: 163 mg/dL
Preoperative diagnosis:
G1P0 Pregnancy uterine 38 4/7 weeks
age of gestation by early ultrasound,
cephalic, in labor; gestational hyperten-
sion; prelabor rupture of membranes x 17
hours; obese class I; nonreassuring fetal
heart rate pattern (recurrent variable de-
celerations) category II
Patient came in for watery vaginal discharge for 6 hours
Prenatal History:
First prenatal check-up was done at 7 weeks age of gestation
with regular visits thereafter. On initial visit, and at 24 weeks
age of gestation, 75 grams OGTT was normal. No maternal ill-
ness or BP elevation noted. Total weight gain was 16 lbs, ide-
ally 11-20 lbs.
History of Present Illness:
Six hours prior to admission, the patient noted watery vaginal
discharge non foul smelling and clear associated with intermit-
tent crampy hypogastric pain radiating to the lumbar area with a
pain score of 5/10. Patient sought consultation with a private
physician and a biophysical profile was requested. It showed in-
trauterine pregnancy, single, cephalic presentation, oligohy-
dramnios with low of AFI 4.6cm DPV of 2.7cm, placenta right
anterolateral and high lying, sonographic estimated fetal weight
of 2644g (5lbs 13oz) within the 10-90 percentile of the normal
th
growth curve pattern, biophysical score of 8/8. Patient was ad-
vised for admission.
On admission:
BP 140/90 mmHg, asymptomatic→ 120/90mmHg, asympto-
matic HR 88 bpm RR 20 cpm Temp 37.1 C 0
Ht. 154 cm Wt. 81.8 kgs BMI 29.3 kg/m (Obese l)
2
Chest and Lungs: clear breath sounds
Abdomen: Gravid, FH: 29cm EFW: 2.48 kgs (6lbs, 13oz)
Speculum exam: (+) pooling, clear
IE: 2 cm, 30% effaced, station -5, ruptured bag of water,
cephalic, firm, midposition Bishop score 2
CTG Category I
UC: 5-6 minutes, 60-90 seconds, MVU 90 FHT 145 bpm
Antibiotic was started
Oxytocin drip was started
4H: BP 140/100 mmHg, asymptomatic→ 120/100mmHg,
asymptomatic
BP range: 120-140/80-100 mmHg, asymptomatic
Chest and Lungs: clear breath sounds
IE: 4 cm , 70% effaced, station -3, ruptured bag of water,
cephalic, medium, midposition Bishop score 3
CTG Category I
UC: 2-3 minutes, 30-60 seconds, FHT 140 bpm, MVU 300,
Temp 36.8
Methyldopa 250mg/tablet 1 tablet every 8 hours was started
Preeclampsia panel was normal
7H: BP 120/80 mmHg, asymptomatic
BP range: 120-130/80 mmHg, asymptomatic
Chest and Lungs: clear breath sounds
IE: 4cm , 70% effaced, station -3, ruptured bag of water,
cephalic
CTG Category II Variable deceleration noted to as low as 80
bpm from baseline FHT of 135 bpm. Oxytocin was discontin-
ued. Resuscitation was done with change in maternal position,
oxygen supplementation, IV hydration, and fetal scalp stimula-
tion. However, variable decelerations persisted from baseline
FHT of 140 bpm down to as low as 95 bpm for 90 minutes.
UC: 3-4 minutes, 40-60 seconds, FHT 135 bpm, Temp: 36.2 C 0
Preoperative Diagnosis:
G1P0 Pregnancy uterine 40 1/7 weeks
age of gestation by last menstrual period,
cephalic in labor; Prelabor rupture of mem-
branes x 34 hours; Nonreassuring fetal
heart rate pattern (recurrent variable de-
celerations) CTG category II;
Patient came in for induction of labor.
Prenatal History:
First prenatal visit was at 5 6/7 weeks age of gestation, with
regular visits thereafter. At 24 3/7 weeks age of gestation, 75
grams OGTT was done with unremarkable results. At 36 2/7
weeks AOG, GBS rectovaginal swab was unremarkable. No
maternal illness nor BP elevations noted during the course of
pregnancy. Total weight gain was 33 lbs, ideally 25-35 lbs for
patient’s BMI.
History of Present Illness:
Hours prior to admission, at 40 1/7 weeks AOG, patient noted
onset of watery vaginal discharge, clear, non-foul smelling as-
sociated with irregular uterine contractions. Patient sought con-
sult and was subsequently admitted.:
On admission:
BP 110/60 mmHg HR 79 bpm RR 19 cpm Temp 36.5 C0
Ht: 155 cm Wt: 45 kg BMI: 19.125 kg/m2 (Normal)
Abdomen: gravid, FH: 33cm EFW: 3.26 kgs (7 lbs 3oz)
SE: (-) pooling, (+) Actimprom
IE: 2cm, 60% -3, ruptured bag of water, cephalic, medium, mid-
position, BS 5
CTG Category I FHT 150 bpm
UC: 1 in 10 minutes, 30-40 seconds, MVU 90, FHT 140 bpm
Oxytocin drip was started
6H: IE: 2cm, 70% effaced, station -3, leaking BOW/cephalic,
soft midposition (BS: 5)
CTG Category I
UC: 6-8 minutes 30-40 seconds, MVU 150, FHT 140 bpm, T
36.7 C
0
Antibiotic coverage was started
12H IE: 3cm, 80% effaced, station -3, leaking BOW/cephalic,
soft, midposition (BS: 8)
CTG: Category I
UC: 4-5 minutes, 40-50 seconds, MVU 200, FHT 130bpm, T
36.5 C
0
16H: IE: 5cm, 80%, station -3, ruptured BOW/cephalic,
CTG: Category I
UC: 2-3 minutes, 40-50seconds, MVU 300 FHT 150bpm, T
36.0C
20H: 5cm, 80%, station -3, ruptured BOW/cephalic
CTG: Category II Fetal Tachycardia with Variable decelerations
noted to as low as 125 bpm from baseline FHT of 180 bpm. Re-
suscitation was done with change in maternal position, oxygen
supplementation, IV hydration, discontinuation of oxytocin drip,
and fetal scalp stimulation. However, variable decelerations
persisted from baseline FHT of 150 bpm down to as low as 75
bpm for 30 minutes.
UC: 2-3 minutes, 40-60seconds, MVU 300 FHT 140bpm T
36.7C
Preoperative Diagnosis:
G1P0 Pregnancy uterine 37 4/7 weeks
age of gestation by early ultrasound,
cephalic in labor; gestational diabetes mel-
litus-medical nutrition therapy, controlled;
Gestational hypertension; Non-reassuring
fetal heart rate pattern (Recurrent variable
deceleration) Category II
Patient came in for watery vaginal discharge for six hours.
Prenatal History:
First prenatal visit was at 10 weeks age of gestation, with regu-
lar visits thereafter. Fasting blood sugar was elevated at 94
mg/dl. Patient was diagnosed with Gestational diabetes mellitus
and was advised diet modification and capillary blood sugar
monitoring with good glycemic control (acbf 81-90 mg/dl, 2H PP
102-115 mg/dl). At 24 weeks age of gestation, congenital
anomaly scan showed no gross congenital anomaly. At 37
weeks age of gestation, biophysical profile scoring was 10/10.
No other maternal illness noted during pregnancy. Total weight
gain of 31 lbs, ideal 25-35 lbs.
History of Present Illness:
Six hours prior to admission, patient had onset of watery vagi-
nal discharge, greenish in color, non-foul smelling, associated
with crampy hypogastric pain, radiating to the lumbar area, with
a pain score of 5/10. Patient sought consultation and was sub-
sequently admitted.
On admission:
BP 120/90 mmHg, asymptomatic→140/90 mmHg, asympto-
matic
HR 72 bpm RR 19 cpm Temp 36.8 C
0
Ht: 155 cm Wt: 50 kg BMI: 20.81 kg/m2 (Normal)
C/L: clear breath sounds
Abdomen: gravid, FH: 30cm EFW: 2.64 kgs (5 lbs 13oz)
SE: (+) pooling thickly meconium-stained amniotic fluid
IE: 4 cm, 60% effaced, station -3, ruptured bag of water,
cephalic, soft, posterior, Bishop score 6
CTG Category I
UC: 2-4 minutes, 60-90 seconds, FHT 145 bpm, MVU 350
Antibiotic started
CBC, Urinalysis, preeclampsia panel, urine protein creatinine
ratio were normal
4H: IE: 5 cm, 70% effaced, station -3, ruptured bag of water,
cephalic
CTG Category I
UC: 2-3 minutes, 30-50 seconds, FHT 130 bpm, MVU 300,
Temp 37.1
BP range: 130-140/80-90 mmHg,asymptomatic
C/L: clear breath sounds
6H: IE: 6cm, 80% effaced, station -3, ruptured bag of water,
cephalic
CTG Category II Variable deceleration noted to as low as 85
bpm from baseline FHT of 145 bpm. Resuscitation was done
with change in maternal position, oxygen supplementation, IV
hydration, and fetal scalp stimulation. However, variable decel-
erations persisted from baseline FHT of 140 bpm down to as
low as 90 bpm.
UC: 2-3 minutes, 30-60 seconds, FHT 140 bpm, MVU 400,
Temp: 36.5C
BP range: 130-140/80-90 mmHg, asymptomatic
C/L: clear breath sounds
Preoperative Diagnosis:
G2P1 (1-0-0-1) Pregnancy uterine 39 4/7
weeks age of gestation by early ultra-
sound, cephalic in labor; Advanced mater-
nal age; Obese class I; Non-reassuring fe-
tal heart rate pattern (Recurrent variable
deceleration) Category II
Patient came in due to labor pain.
OB History G2P1 (1-0-0-1)
G1-2015, normal spontaneous vaginal delivery, hospital deliv-
ery, term, female, 2600 grams, no known complications, living
G2- present pregnancy
Prenatal History:
First prenatal visit was at 8 weeks age of gestation, with regular
visits thereafter. Aspirin 100mg/tablet, 1 tablet once daily was
started. 75 grams OGTT was normal. At 24 weeks age of ges-
tation, congenital anomaly scan showed no gross congenital
anomaly. No other maternal illness noted during pregnancy. To-
tal weight gain of 18 lbs, ideal 11-20 lbs.
History of Present Illness:
Four hours prior to admission, patient had onset of irregular
crampy hypogastric pain, radiating to the lumbar area, with a
pain score of 5/10. No watery nor bloody vaginal discharge.
Persistence of hypogastric pain prompted consult and subse-
quent admission.
On admission:
BP 120/80 mmHg HR 72 bpm RR 19 cpm Temp 36.8 C 0
Ht: 151 cm Wt: 62 kg BMI: 27.2 kg/m2 (Obese)
Abdomen: gravid, FH: 31cm EFW: 2.79 kgs (6 lbs 3oz)
IE: 5 cm, 80% effaced, station -3, intact bag of water, cephalic
CTG Category I
UC: 3-4 minutes, 30-60 seconds, FHT 150 bpm, MVU 300
2H: Spontaneous rupture of membranes, thickly meconium-
stained amniotic fluid
IE: 8 cm, 80% effaced, station -3, ruptured bag of water,
cephalic
CTG Category I
UC: 2-3 minutes, 60-90 seconds, FHT 130 bpm, MVU 400,
Temp 37.1
4H: IE: 9 cm, 90% effaced, station -3, ruptured bag of water,
cephalic
CTG Category II Variable deceleration noted to as low as 70
bpm from baseline FHT of 135 bpm. Resuscitation was done
with change in maternal position, oxygen supplementation, IV
hydration, and fetal scalp stimulation. However, variable decel-
erations persisted from baseline FHT of 145 bpm down to as
low as 80 bpm for 90 minutes.
UC: 2-3 minutes, 60-90 seconds, FHT 145 bpm, MVU 400,
Temp: 36.5C
Preoperative Diagnosis:
G1P0 Pregnancy Uterine 38 6/7 weeks age of
gestation, cephalic, in labor; Advanced Maternal
Age; Multiple Uterine Myoma WHO Grade 3-4;
Advanced Maternal Age; status post Thyroidec-
tomy, Total, Left, with Isthmusectomy (2010);
status post Completion Thyroidectomy (2016), in
euthyroid state; Nonreassuring fetal heart rate
pattern (prolonged decelerations) CTG category
II; Multiple myoma uteri
Patient came in for labor pain.
Past Medical and Surgical History
Thirteen years prior to admission, the patient noted an anterior neck
mass and was asymptomatic. Patient immediately sought consultation.
Work-up was done which showed Colloid nodular goiter, left and was
biochemically euthyroid. She was advised for Left Thyroid Lobectomy.
Patient complied, underwent surgery and tolerated the procedure well
with no maintenance medications thereafter.
Seven years prior to admission, there was an increase in size of her re-
maining right thyroid lobe, still asymptomatic, and was advised for Com-
pletion Thyroidectomy. Patient underwent surgery, tolerated the proce-
dure well and was maintained on Levothyroxine 25 mcg/ tab 1 tab OD
PO since then.
History of Present Illness:
Four hours prior to admission, patient had an onset of hypogastric pain
radiating to the lumbar area with a pain score of 8/10 associated with
bloody vaginal discharge. There was no associated watery vaginal dis-
charge. Persistence of symptoms prompted consult hence this admis-
sion.
On admission:
BP 110/70 mmHg HR 80 bpm RR 19 cpm Temp 36.4 C0
Ht: 156 cm Wt: 50 kg BMI: 20.55 kg/m2 (Normal)
HEENT: trachea midline, thyroid gland not palpable
Abdomen: gravid, FH: 33cm EFW: 3.100 kgs (7 lbs 2oz)
IE: 4 cm, 80% -3, intact bag of water, cephalic, medium, midposition
(BS 7)
CTG Category I FHT 140 bpm
UC: 4-6 mins, 30-40 seconds, MVU 200, FHT 140 bpm
6H: IE: 5 cm, 80% -3, intact bag of water, cephalic
CTG Category I
UC: 5-6 mins 30-60 seconds, MVU 200, FHT 140 bpm, T 36.5 C 0
Oxytocin drip was started
10H IE: 6cm, 80% effaced, station -3, ruptured BOW/cephalic
CTG: Category I
UC: 2-3 minutes, 40-90seconds, MVU 300, FHT 130bpm
12H IE: 9cm, 80% effaced, station -3, ruptured BOW/cephalic
CTG: Category I
UC: 2-3 minutes, 40-90seconds, MVU 300, FHT 130bpm
14H IE: 9cm, 80% effaced, station -3, ruptured BOW/cephalic
CTG: Category II Fetal Variable decelerations noted to as low as 75 bpm
from baseline FHT of 145 bpm. Resuscitation was done with change in
maternal position, oxygen supplementation, IV hydration, oxytocin drip
was discontinuation of oxytocin drip, and fetal scalp stimulation. How-
ever, variable decelerations persisted from baseline FHT of 135 bpm
down to as low as 95 bpm for 90 minutes.
UC: 2-3 minutes, 40-90seconds, MVU 300 FHT 140bpm Temp: 36.7C
Preoperative diagnosis: Patient came in for labor pain
G1P0 Pregnancy uterine 38 4/7 weeks
age of gestation, breech, in labor Prenatal History:
First prenatal visit was at 13 weeks AOG with regular visits
thereafter. At 24 weeks AOG, 75 grams OGTT was normal. At
34 weeks AOG, pelvic ultrasound showed pregnancy uterine,
live, singleton, footling breech in presentation, adequate amni-
otic fluid (AFI 5.9 cm, DVP 2.4 cm), placenta posterior, grade II,
high lying, sonographic estimated fetal weight of 1788 grams
(3lb, 15oz) was below the fifth percentile of the normal growth
curve pattern for a 34 week fetus. Fetal Doppler studies
showed a sonographic estimated fetal weight of 1999 grams
and was within the 10 -25 percentile of the normal growth
th th

curve for a 34 week fetus. The S/D ratio and the resistance in-
dex (RI) of both uterine arteries are elevated suggestive of in-
creased resistance to flow in these vessels with presence of
right uterine artery notching. Cerebroplacental ratio (CPR) is at
1.61. Patient was prescribed with amino acid +multivitamins
(Onima) 3x a day, 1 egg white/meal, strict fetal kick counting.
Patient was appraised for possible Cesarian Section if persis-
tence of malpresentation continues during term. At 35 weeks
AOG, biophysical profile showed pregnancy uterine live, single-
ton, complete breech presentation, adequate amniotic fluid
(DVP 5.1 cm, AFI 13 cm), placenta located left lateral, grade II,
high lying, sonographic estimated fetal weight of 2,486 grams
which was within the 25 -50 percentile of the normal growth
th th

curve of a 35-36 week fetus, BPS 10/10. At 37 6/7 weeks,

pelvic ultrasound showed pregnancy uterine, live singleton,
breech presentation, adequate amniotic fluid (AFI 12.5cm, DVP
3.1cm), placenta posterior, grade II-III, high lying, sonographic
estimated fetal weight of 2734 grams (6 lbs, )oz) and was within
the 10 -25 percentile of the normal growth curve pattern for 37-
th th

38 week fetus. No blood pressure elevation nor maternal illness

noted during pregnancy. Total weight gain was 27 lbs, ideally
25-35 lbs.

History of present illness:

Six hours prior to admission, the patient had an onset of inter-
mittent crampy hypogastric pain, radiating to the lumbar area,
with a pain score of 4/10, not associated with watery or bloody
vaginal discharge. Patient sought consult and advised for a pri-
mary low segment cesarean section. Thus, this admission.

On admission:
BP 120/80 mmHg HR 63 bpm RR 19 cpm Temp 36.0 C 0

Ht. 146 cm Wt. 62.4 kg BMI: 23.45 kg/m (Normal)

2

Abdomen: Gravid, FH: 30 cm EFW: 2.6kg (5lbs 11oz)

Leopold’s Maneuver:
L1- cephalic
L2- fetal parts on the maternal right side, fetal small parts at left
maternal side
L3- Breech
L4- not applicable

IE: 5 cm dilated, 90% effaced, station - 3, medium, midposition,

intact bag of water, breech, Bishop score of 8
CTG Category I
UC: Every 5-6 minutes, 90-120 seconds, MVU 160, FHT 130
bpm
Preoperative Diagnosis:
G1P0 Pregnancy uterine 40 weeks age of
gestation by early ultrasound, cephalic in
labor; gestational diabetes mellitus-medi-
cal nutrition therapy, controlled; dysfunc-
tional labor (failed induction of labor)
Patient came in for induction of labor.
Prenatal History:
First prenatal visit was at 7 weeks age of gestation, with regular
visits thereafter. Fasting blood sugar was elevated at 95 mg/dl.
Patient was diagnosed with Gestational diabetes mellitus and
was advised diet modification and capillary blood sugar moni-
toring with good glycemic control (acbf 80-93 mg/dl, 2H PP
108-119 mg/dl). At 24 weeks age of gestation, congenital
anomaly scan showed no gross congenital anomaly. Starting at
37 weeks age of gestation, serial biophysical profile scoring
was 10/10. No other maternal illness noted during pregnancy.
Total weight gain of 29 lbs, ideally 25-35 lbs.
History of Present Illness:
One hour prior to admission, patient had her prenatal check up
and was advised for labor induction. The patient had no com-
plaints of hypogastric pain, watery nor bloody vaginal dis-
charge. The patient was then subsequently admitted.
On admission:
BP 110/60 mmHg HR 90 bpm RR 19 cpm Temp 36.5 C 0
Ht: 153 cm Wt: 50 kg BMI: 21.4 kg/m2 (Normal)
Abdomen: gravid, FH: 35cm EFW: 3.41 kgs (7 lbs 8oz)
IE: admits tip
NST Reactive, FHT 150 bpm
Dinoprostone 0.5mg endocervical gel was started
Clinical Pelvimetry:
Diagonal conjugate: 10 cm
Sacral promontory palpable
6H: IE: admits tip
NST reactive, FHT 145 bpm
Dinoprostone 0.5mg endocervical gel 2nd dose was given
12H: IE: 1cm, slightly effaced, station -5, intact BOW, cephalic,
medium, midposition, Bishop score 3
CTG Category I
UC: 1 in 10 minutes, 60 seconds, FHT 145 bpm, MVU 100,
Temp 37.0 C
Dinoprostone 0.5mg endocervical gel 3rd dose was given
24H: IE: 2cm, 50% effaced, station -3, intact BOW, cephalic,
medium, midposition, Bishop score 4
CTG Category I
UC: 5 minutes, 60-90 seconds, FHT 150 bpm, MVU 200, Temp
37.3 C
Cervical ripening with evening primrose oil 4 capsules intravagi-
nally was given every 6 hours
30H: IE: 3cm, 50% effaced, station -3, intact BOW, cephalic,
medium, midposition, Bishop score 5
CTG Category I
UC: 4-5 minutes, 60-90 seconds, FHT 140 bpm, MVU 200,
Temp 37.0 C
32H: Spontaneous rupture of membranes, clear amniotic fluid
IE: 4cm, 70% effaced, station -3, ruptured BOW, cephalic,
medium, midposition, Bishop score 6
CTG Category I
UC: 4-5 minutes, 60 seconds, FHT 145 bpm, MVU 170, Temp
37.1 C
Oxytocin drip started
38H: IE: 4cm, 70% effaced, station -3, ruptured BOW, cephalic,
medium, midposition, Bishop score 6
CTG Category I
UC: 2-4 minutes, 60-90 seconds, FHT 150 bpm, MVU 300,
Temp 36.5 C
Ampicillin 2 grams IVTT given

44H: IE: 4cm, 70% effaced, station -3, ruptured BOW, cephalic,
medium, midposition, Bishop score 6
CTG Category I
UC: 2-4 minutes, 60 seconds, FHT 150 bpm, MVU 300, Temp
36.7 C

46H: IE: 4cm, 70% effaced, station -3, ruptured BOW, cephalic,
medium, midposition, Bishop score 6
CTG Category I
UC: 3-5 minutes, 60-90 seconds, FHT 145 bpm, MVU 300,
Temp 36.7 C
Preoperative Diagnosis:
G2P0 (0-0-1-0) Pregnancy uterine 38
weeks age of gestation by last menstrual
period, cephalic in labor; gestational dia-
betes mellitus - medical nutrition therapy
controlled; prelabor rupture of membranes
for 20 hours; failed induction of labor
Patient came in due to watery vaginal discharge for 3 hours.
OB History G2P0 (0010)
G1- 2019, Complete abortion, 11 weeks age of gestation, no di-
latation and curettage done
G2- Present pregnancy
Prenatal History:
First prenatal visit was at 7 weeks age of gestation, with regular
visits thereafter. On initial visit, 75g OGTT FBS showed ele-
vated FBS of 95 mg/dl. HbA1c was normal at 5.7%. Patient was
advised for diet modification and capillary blood sugar monitor-
ing with good glycemic control (acbf 80-90 mg/dl 2HPP 95-110
mg/dl). At 28 week age of gestation, congenital anomaly scan
showed no gross congenital anomaly. At 37 weeks age of ges-
tation, biophysical profile showed intrauterine pregnancy, live,
singleton, cephalic in presentation; adequate amniotic fluid vol-
ume (AFI 8.8 cm DVP 2.7 cm); placenta anterior, high lying;
and sonographic estimated fetal weight (3120 grams) is appro-
priate for gestational age; biophysical profile score of 10/10. No
other maternal illness or BP elevation noted. Total weight gain
was 30 lbs, ideally 15-25 lbs.
History of Present Illness:
Three hours prior to admission, patient noted watery vaginal
discharge, clear, non-foul smelling associated with intermittent
crampy hypogastric pain radiating to the lumbar area with a
pain score of 4/10. Patient sought consultation and was subse-
quently admitted.
On admission:
BP 120/80 mmHg HR 82 bpm RR 18 cpm Temp 35.60C
Ht. 156 cm Wt. 72.5 kgs BMI 23.8 kg/m2 (Overweight)
Abdomen: Gravid, FH: 33 cm EFW: 3.10 kgs (6lbs, 13oz)
Speculum exam: (+) pooling, clear amniotic fluid
IE: 2 cm, 60% effaced, station -3, ruptured bag of water,
cephalic, soft, midposition, Bishop score 6
CTG Category I
UC: 3-4 minutes, 60-90 seconds, FHT 135 bpm, MVU 185,
Temp 36.7C
Oxytocin drip started.
Clinical Pelvimetry:
Diagonal conjugate: 11.5 cm
Sacral promontory not palpable
6H: IE: 3 cm, 60% effaced, station -3, ruptured bag of water,
cephalic, soft, midposition, Bishop score 7
CTG Category I
UC: 2-3 minutes, 60-90 seconds, FHT 140 bpm, MVU 300,
temp 37C
Antibiotics was started.
12H: IE: 4 cm, 70% effaced, station -3, ruptured bag of water,
cephalic, soft, midposition, Bishop score 7
CTG Category 1
UC 2-3 minutes, 60-90 seconds, FHT 145 bpm, MVU 300,
Temp 37.2C
16H: IE: 4 cm, 70% effaced, station -3, ruptured bag of water,
cephalic, soft, midposition, Bishop score 7
CTG Category 1
UC 3-4 minutes, 30-60 seconds, FHT 150 bpm, MVU 300,
Temp 36.9C
Preoperative Diagnosis:
G1P0 Pregnancy uterine 37 1/7 weeks
age of gestation by last menstrual period,
cephalic, not in labor; placenta previa not
in active bleeding; bilateral ovarian new
growth probably benign
Patient came in for a scheduled cesarean section and possible
bilateral oophorocystectomy.
Prenatal history:
First prenatal visit was at 17 weeks age of gestation with regu-
lar visits thereafter. At 17 weeks age of gestation, pelvic ultra-
sound showed intrauterine pregnancy, live, singleton, breech in
presentation; adequate amniotic fluid (DPV 2.8 cm); placenta
posterior, totally covering the internal os; sonographic esti-
mated fetal weight (228 grams) is appropriate for gestational
age; cervix (3.12 cm) long and closed; bilateral ovarian cysts
(Right ovary: within is a thick walled unilocular cyst containing
diffuse low level echoes measuring 4 x 3.8 x 2.2 cm; Left ovary:
within is a thick walled unilocular cyst containing diffuse low
level echoes measuring 3.3 x 3.2 x 2.6 cm adherent to the pos-
terior uterus) both with sonologic features of endometriotic cyst;
pelvic adhesions considered. No hypogastric pain, or bloody
vaginal discharge. Patient was advised to watch out for hy-
pogastric pain, or bloody vaginal discharge and for repeat
pelvic ultrasound at 32 weeks for placental localization. At 24
weeks age of gestation, 75 grams OGTT was normal. At 33
weeks age of gestation, pelvic ultrasound showed intrauterine
pregnancy, live, singleton, transverse lie; adequate amniotic
fluid (AFI 14 DPV 4.6 cm); placenta posterior, totally covering
the internal os; sonographic estimated fetal weight (2108
grams) is appropriate for gestational age; cervix (3.8 cm) long
and closed; bilateral ovarian cysts (Right ovary: within is a
unilocular cyst containing diffuse low level echoes measuring
3.7 x 2.2 x 1.6 cm; Left ovary: within is a thin walled unilocular
anechoic cyst measuring 4 x 4.4 x 2.6 cm) both with sonologic
features of endometriotic cyst. No hypogastric pain, or bloody
vaginal discharge. Dexamethasone 6 mg deep IM every 12
hours for 4 doses was given. Patient was advised for repeat
pelvic ultrasound at 36 weeks for final placental location and
presentation. Patient was not advised for surgery. At 36 weeks
age of gestation, pelvic ultrasound showed intrauterine preg-
nancy, live, singleton, cephalic; adequate amniotic fluid (AFI
20.5 cm, DPV 6.9 cm); placenta posterior, totally covering the
internal os; and sonographic estimated fetal weight (2559
grams) is appropriate for gestational age; right and left ovarian
cysts were not visualized. Patient was appraised for an elective
cesarean section with possible oophorocystectomy at 37 weeks
age gestation or anytime if with onset of vaginal bleeding. No
blood pressure elevation nor other maternal illness was noted.
Total weight gain was 20 lbs, ideally 25-35 lbs.
History of Present Illness:
Patient came in for an elective cesarean section and possible
bilateral oophorocystectomy. Patient had no hypogastric pain,
watery or bloody vaginal discharge.
On admission:
BP 120/80 mmHg HR 82 bpm RR 20 cpm Temp 36.3 C 0
Ht. 159 cm Wt 68 kg BMI: 20.6 kg/m2 (Normal)
Abdomen: gravid, FH: 32 cm EFW: 2.94 kgs (6 lbs 6 oz)
Speculum Exam: Closed cervix, no bloody discharges, no pla-
cental tissue
CTG Category I
UC: 1 in 10 minutes, 60-90 seconds, FHT 140 bpm, MVU 40
Preoperative Diagnosis:
G1P0 Pregnancy uterine 35 weeks age of
gestation by last menstrual period,
cephalic in preterm labor; Placenta previa
in active bleeding; Gestational diabetes
mellitus-medical nutrition therapy, con-
trolled; Obese class I; Advanced maternal
age
Patient came in for bloody vaginal discharge.
Prenatal History:
First prenatal visit was at 7 weeks age of gestation, with regular
visits thereafter. Aspirin 100 mg/tablet 1 tablet once daily was
started. 75 grams OGTT showed elevated fasting blood sugar
at 96 mg/dl and normal 2 hours postprandial glucose of 151
mg/dl. Patient was diagnosed with Gestational diabetes mellitus
and was advised diet modification and capillary blood sugar
monitoring, with good glycemic control (acbf 85-94 mg/dl, 2H
PP 100-115 mg/dl). At 26 weeks age of gestation, congenital
anomaly scan showed Pregnancy uterine, 26 weeks 4 days by
fetal biometry, live, singleton, cephalic presentation, adequate
amniotic fluid volume, placenta left posterolateral, Grade 2, to-
tally covering the internal cervical os, Sonologic EFW is within
the 10th-90th percentile of the normal growth curve pattern for
a 26-27 week fetus, no gross congenital anomaly, and was ad-
vised for repeat pelvic ultrasound near term. No other maternal
illness noted during pregnancy. Total weight gain of 15 lbs, ide-
ally 11-20 lbs.
History of Present Illness:
Three hours prior to admission, patient noted sudden onset of
bloody vaginal discharge, using two moderately soaked panty
liners associated with regular crampy hypogastric pain, radiat-
ing to the lumbar area with a pain score of 1/10, not associated
with watery vaginal discharge. Patient sought consult and was
subsequently admitted.
On admission:
BP 120/80 mmHg HR 73 bpm RR 20 cpm Temp 36.5 C 0
Ht: 155 cm Wt: 75 kg BMI: 25 kg/m2 (Obese class I)
Skin: (-) pallor
Abdomen: gravid, soft FH: 29cm EFW: 2.48 kgs (5 lbs 7oz)
SE: (+) minimal bloody discharge with blood clots
CTG Category I
UC: 1-2 minutes, 60-90 seconds, FHT 135, MVU 300