Patient Name: Nazia Saghir Husband Name: Saghir Ahmed Age 28 years LMP: 23/5/11 EDD: 27/2/2012 EDD

according to USG: 2/3/12 GA 35 Weeks and 4 days G4P3 +3

Presenting Complain: Gestational Amenorrhea for 35 weeks.

History of Presenting Complain: This is her 4th pregnancy and is a planned spontaneous pregnangy which was confirmed by ultrasound and blood HCG levels.

1st Trimester: There is no history of bleeding vomiting or hyperemesis gravidarum. She did not have develop any rash or fever. She did not have any episode of UTI during this time. She has been taking folic acid and Calcium supplements which were advised to him by a doctor at SHIFA. 2nd Trimester: Her anomaly scan was done at shifa which was normal. Quickening was at 5 months. She did not have any episode of bleeding , vaginal discharge or UTI. She got her first tetnus toxoid injection in September and second injection in October. She has been taking folic acid and calvium supplemts regularly. 3rd Trimester: She feels 20-25 fetal movments every day. She does not have any contraction or abdominal pain. No history of blood or vaginal discharge.

Review of systems: CNS: No Headache, No visual disturbances, No Fits CVS: No hypertension, No palpitations, No Edema Respiratory: No dyspnea or Cough

GIT: No constipation, No vomiting, no diarrhea,

Past Obstetric history: Her first pregnancy was in 2007 at SHIFA, which was SVD and the baby girl was born who died after 1 hour due to birth asphyxia. Second pregnancy was in 2008 and she had a miscarriage at 10 weeks. Third pregnancy was in 2009, SVD, male child was born who died on 13th January 2012, due to Congenital heart disease. She developed GDM during this pregnancy

Mensuration history: She has regular cycles with 7days/28days She has not used any contraception Surgical history: NONE Past medical History. She developed GDM in her last pregnancy. No hypertension, Allergies, DVT, Respiratory distress or Jaundice. She is not using any prolonged Medicines. Family history is positive for Diabetes and Hypertension Social history: Her husband owns a general store. They use Water from a well which they do not boil. They have a comfortable living. She is a non-smoker.

General Physical Examination: Height: 126 Cm Weight: 60Kgs Pulse: 87/min Temperature: Afebrile Blood pressure: 120/80 Pallor Present in eyes and hands. Capillary refill: Less than 2 seconds.

Respiratory rate:22/min No Clubbing or Kilonychia No neck swellings No varicose veins: Abdominal Examination: Inspection. Protuberant abdomen, without any scars. The Umbilicus was inverted and centrally placed. There were no veins visible. Stria gravidarum were visible. Palpation: Non tender abdomen, with SFH of 36 cms. Lie of the fetus was 36 cms. And liquor volume was decreased.