The Case of E.S.

Identifying Data: Eliza Seno is a 26- year old, G1P0 (0000), Filipina, unemployed , single, Iglesia ni Cristo from Sandiganbayan, Quezon City who had her fourth prenatal checkup at Quirino Memorial Medical Center on May 22, 2012 Source and Reliability: Information was gathered from the patient herself; she seemed to have good reliability.

OB History
G1P0 (0000) LMP: November 10, 2011 AOG: 28 weeks and 3 days EDD: August, 17 ,2012

(-) abortions Menstrual History
Menarche: 12 years old Interval: 30 days, regular Duration: lasts for 5 days Amount: 3 pads/day Severity: moderate (+) dysmenorrhea (-) intermenstrual bleeding Chief Complaint: “hindi masyado magalaw ung isang baby ko” History of Present Pregnancy Patient was regularly menstruating until five months prior to consult when she noted of missed menses. Patient had been sexually active, with frequency of coitus noted to be at four times per month with one partner. Patient undertook a pregnancy test, where she tested positive. There was no associated headaches, dizziness, breast tenderness, nausea, abdominal pain, easy fatigability and low back pain. Patient did not seek consult with a health professional at this time. Patient’s condition remained the same until three months prior to consult when she first experienced loss of appetite and shortness of breath. There was no associated headache, dizziness, breast tenderness, nausea, abdominal pain, easy fatigability, and low back pain. Patient did not seek consult with a physician. Patient’s condition remained the same until two months prior to consult when she first noted of fetal movements. Due to sensation of fetalmovements, patient decided to have her first prenatal checkup on April 17, 2012 at the Obstetrics and Gynecology Outpatient Department (OB/GYN OPD) of the Quirino Memorial Medical Center, where she was advised to undertake a pelvic ultrasound. Results from the ultrasound revealed that the patient had two intrauterine alive fetuses. She had her second prenatal checkup at the Obstetrics and Gynecology Outpatient Department of the Quirino Memorial Medical Center on April 23, 2012, where she was referred to the perinatology department of the QMMC. She had her third prenatal checkup at the Perinatology Outpatient Department of the Quirino Memorial Medical Center on May 5, 2012, where she was advised to undergo a repeat pelvic ultrasound. Results from the ultrasound indicate that the patient had a multifetalpregnancy (cephalic-breech) monochorionic diamnionic type, with intertwin discordancy of 34%. Patient had her fourth prenatal checkup at the Perinatology Department of the Quirino Memorial Medical Center on May 22, 2012 , where patient noted of good fetal movements on her lower

sought consult at the perinatology OPD. abdominal pain. with intertwin discordancy of 34%. whitish. Sexual History Age on 1st coitus. experienced loss of appetite and shortness of breath -still no headache. and poor fetal movements on her left abdominalarea. low back pain -did not seek consult with health professional -condition remained the same till 3 months PTC.minimal. Due to poor fetal movements of one of her fetuses. noted of fetal movements -due to sensation of fetal movements.20 years old Number of sexual partners – 7 Frequency of coitus. thick discharge (-) nausea/vomitting (-) headache (-) dizziness (-) vaginal bleeding (-) fever. she was advised to be admitted at the Obstetrics and Gynecology Emergency Room.second prenatal checkup at OB OPD.right abdominal area. breast tenderness. breast tenderness. -Repeat UTZ revealed multifetalpregnancy (cephalic-breech) monochorionic diamnionic type. easy fatigability.advised to undertake repeat pelvic UTZ. frequency of coitus – 4x /month -tested positive with a pregnancy test -no headaches. low back pain -did not seek help with a physician -condition stable till 2 months PTC. GI pain. QMMC (advised to undergo pelvic UTZ) -ultrasound revealed two intrauterine alive fetuses . Px noted good fetal movements on right.april 23. wentf for first prenatal checkup on April 12. 2012-referred to perinatology dept QMMC due to twin pregnnacy. 2012 at OB OPD. -Third prenatal checkup at perinatology OPD May5. noted missed menses -sexually active.4 times per month (-) dyspareunia Contraceptives Use (-) pills (-) Natural family planning method . easy fatigability. chills (-) dysuria (-) abdominal pain (-) pelvic pain (-) blurring of vision Due to poor fetal movements of one of her twins. dizziness. -regularly menstruating until 5 months PTC. nausea. and poor fetal movements on left (+) edema of lower extremities (+) breast. 2012. 5 hours PTC. nausea. dizziness.

(-) temperature intolerance. thick. Nose. (-) jaundice Urinary. (-) skin changes Head. (-) goiter. (-) indigestion. 2011 . (-) history of depression. (-) leg pain Musculoskeletal. (+)polydipsia. (-) motor or sensory loss Hematologic. (-) chest pain. Eyes. Nose. (-) history of phlebitis. (-) sinus problems. (-) lumps. November 21. nor vertigo. moderate in amount. (-) changes in bowel movements (-) diarrhea.16 years old. (-) orthopnea. (-) seizures. (-) fainting. (-) swollen glands. Respiratory: (-) cough.resolved with water therapy (+) anemia (-) Pertinent childhood illnesses (-) HPN (-) DM (-) PTB (-) cancer (-) asthma (-) heart disease (-) kidney disease (-) surgeries (-) allergies to food and drugs Incomplete immunizations (unrecalled) Family History Family of M. sinuses: (-) colds. (-) Weight changes Skin. (-)rashes. (-) joint pains Psychiatric. (-) bleeding.22 years old. (-) pain. Throat (HEENT) Eye: (-) eye problems Ears: (-) hearing difficulty on both ears. (+) vaginal discharge= yellow-white.resolved with antibiotics Recurrence of UTI. Neurologic. (-) wheezing Cardiovascular. (-) anemia Endocrine. Ears. (-) frequency. Throat: (-) hoarseness Neck.G. (-) excessive sweating. foul-smelling Peripheral vascular.(-) condoms (-) injectables (-) IUD (-)HRT Review of Systems General. (-) easy bleeding. nor ear infections. (+) polyuria Past Medical History UTI. (-) dysuria. no tinnitus. (-) recent flank pain. (-) hematuria. (-) palpitations Gastrointestinal. (-) nocturia Genital.

Partner Interest in Issue High High (the partner regularly visits the patient in the OB ward) High High High Moderate Moderate Moderate Moderate Moderate Role Dependent Secondary bread winner Level of Influence High High (partner helps in deciding what actions to take whenever the patient gets sick) High High High Moderate Moderate Moderate Moderate Moderate Father Mother Grandmother Sibling 1 Sibling 2 Sibling 3 Sibling 4 Sibling 5 Breadwinner Primary Caregiver Secondary caregiver Dependent Dependent Dependent Dependent Dependent . Sibling 3.Father Mother Sibling 1. drinks 1 liter of Red Horse and Tanduay Ice Educational attainment: finished high school Ususal diet: Breakfast. Sibling 4.paternl uncle. and 6 nieces Smoking. Sibling 7 (+) PTB.banana cue or bread Dinner – rice + pork/chicken/fish Stakeholder’s Analysis: Stakeholder E. Sibling 5 px. Sibling 2.bread. maternal grandmother (-) cancer (-) DM (-) heartdisease (-) allergies (-) drug reaction (-) asthma (-) history of twin pregnancies Personal and Social History Previously worked as a cashier but stopped December 2011 after confirming that she is pregnant Lives in a 54 square meter house in Sandiganbayan QC with his parents.1 cigarette stick per month for the past 3 years Alcohol.rice + pork/chicken/fish Merienda.S. coffee (1x / week).2x month – per occasion. 6 siblings. and grandmother. milk (2x / day) Lunch.mother. paternal grandfather (+) HPN.

Sibling 6 Sibling 7 Moderate Moderate Dependent Dependent Moderate Moderate Physical Examination: General apperance: coherent. alert .

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