Admitting conference

October 9 - 10
DRs MACASPAC/ RONQUILLO-SARMIENTO
PGIs SHRESTHA/ VITUG

`

OB-CASES

GYNE-CASES

(i) Service

1 (pathologic)

0

(ii) Private

2 (non-pathologic)

0

(i) Service

0

0

(ii) Private

1 (pathologic)

2

RESOLVED:

UNRESOLVED:

Total: 6

Ward Census
FLOOR

OLD

NEW

REFERRAL

TOTAL

3RD MB

1

2

0

3

3RD MT

0

1

0

1

5TH MB

1

0

0

1

5TH MT

1

1

0

2

8Th MT

1

2

0

3

ICU

0

0

0

0

TOTAL

6

10

33 G2P1 (1001) Filipino Guagua CC: increase in blood pressure .Patient Profile # 1 MB.

• • • • • Few hours PTA (+) ↑ BP of 184/130 (+) Headache (-) Nausea/ Vomiting (-) vaginal bleeding (-) hypogastric pain • Consult History of Present Illness .

2yr ago • Asthmalin • (-) Allergy • (-) Goiter • (-) hepatitis FAMILY HX • • • • • (+) DM.PAST MEDICAL • (+) HPN x 15 yr • Aldomet • (-) DM • (+) Asthma • Last attack.paternal (-) ASTHMA (-) CA (-) heart disease P AND S HX • (-) Smoker • (-) Alcoholic bev. Drinker • Catholic • college graduate • unemployed • Married .maternal (+) HTN.

2. Private Hospital.2 kg. CSI x Preeclampsia. alive  G2 : Present Pregnancy  LMP: unsure  EDC: 12/20/2014 by UTZ  AOG: 29 5/7 wks .Obstetrics History  G2P1 (1001)  G1 : 2006. FTBB.

3-6 mo D= 5 DAYS A= 5 PPD/FULLY SOAKED S=(-) DYSMENORRHEA 1st SC: #SP:  (+) OCP use – 1 YEAR (2009)  (-) Post-Coital Bleeding  (-) Dyspareunia  (-) Pap Smear .Gynecologic History M=13 Y/O I= Irregular.

coherent. not in cardio-respiratory distress  Vital signs:  BP: 170/120 PR: 87 RR: 19 Temp: 36oC  Height: 5’5”  Previous Weight: 51 kg.7 kg/m2  Current Weight: 60 kg. gain: 9 kg . BMI= 22 kg/m2  Wt.PHYSICAL EXAMINATION  General: awake. BMI= 18. conscious.

PHYSICAL EXAMINATION  HEENT: pink palpebral conjunctivae. (-) retractions. anicteric sclerae  Lungs: symmetrical chest expansion. clear breath sounds  Heart: adynamic precordium. normal rate and rhythm . (-) murmur.

engaged) LM4: head descent. + striae  FH: 30cm FHT 140s Leopold’s maneuver: LM1: large. (-) edema . non tender. irregular mobile parts on the left maternal side LM3: hard. cephalic prominence on the opposite side of the fetal back IE: Cervix closed  Extremities: full and equal pulses. round non-ballotable structure (cephalic. nodular mass occupies the fundus (breech) LM2: hard resistant structure on the right maternal side.PHYSICAL EXAMINATION  Abdomen: globular.

UC: none . moderate variability. (+) accelerations. (-) decelerations.Initial CTG B FHT: 150-155s.

Admitting diagnosis G2P1 (1001) PU 29 6/7 weeks AOG. Not in labor Chronic hypertension with superimposed severe preeclampsia .

PLAN  MgSO4 5g deep IM on each buttocks  Hydralazine 5mg/IV  Dexamethasone 6mg/IM  MgSO4 drip – MgSO4 10g in PNSS 500cc x 100cc/hr .

Patient Profile # 2 MG. 31 G2P1 (1001) Filipino Mabalacat CC: Hypogastric pain .

• • • • Few hours PTA (+) Hypogastric pain (+) Bloody mucoid discharge (-) Watery vaginal discharge (+) Good fetal movement • Consult History of Present Illness .

paternal (+) HTN.PAST MEDICAL • • • • • • (-) HPN (-) DM (-) Asthma (-) Allergy (-) Goiter (-) hepatitis FAMILY HX • • • • • • (+) DM.paternal (-) PTB (-) ASTHMA (-) CA (-) heart disease P AND S HX • (-) Smoker • (-) Alcoholic bev. Drinker • Married • Catholic • College graduate • Ophtha Nurse .

(-) complications. alive  G2 Present pregnancy  LMP Jan.Obstetrics History  G2P1 (1001)  G1 2012. NSD.. 6lbs. FTBG.>10 . 2014  EDC 10/17/14 by UTZ  AOG 38 6/7 1st PNCU – 6 weeks AOG #PNCU . lying-in clinic.

30 day cycle D= 4 DAYS A= 4-5 PPD/MODERATELY SOAKED S=(-) DYSMENORRHEA 1st SC: 20 #SP: 1  (-) OCP use  (-) Post-Coital Bleeding  (-) Dyspareunia  (-) Pap Smear .Gynecologic History M=13 Y/O I= Regular.

4 kg/m2  Previous Weight: 160 lbs. BMI= 26.7 kg/m2  Wt. coherent.PHYSICAL EXAMINATION  General: awake. not in cardio-respiratory distress  Vital signs:  BP: 130/80 PR: 84 RR: 18 Temp: 36. BMI= 22. conscious.6oC  Height: 5’5”  Previous Weight: 134 lbs. gain: 26 lbs .

anicteric sclerae  Lungs: symmetrical chest expansion. clear breath sounds  Heart: adynamic precordium. normal rate and rhythm .PHYSICAL EXAMINATION  HEENT: pink palpebral conjunctivae. (-) murmur. (-) retractions.

irregular mobile parts on the left maternal side LM3: hard. soft (1). engaged) LM4: head descent. 60 % effaced (2). cephalic prominence on the opposite side of the fetal back IE: Cervix 3 cm dilated (2). Station -3 (0) Bishop score: 5 . posterior position (0). (+) BOW. non tender  FH: 34cm FHT 140s EFW: 3410 gm Leopold’s maneuver: LM1: large. round non-ballotable structure (cephalic. nodular mass occupies the fundus (breech) LM2: hard resistant structure on the right maternal side. cephalic. med.PHYSICAL EXAMINATION  Abdomen: globular.

Montevideo units: 360 . UC: moderate contractions every 2-3 minutes in a 20 min. (-) decelerations. strip. (+) accelerations.Initial CTG B FHT: 150-155. Moderate variability.

Labor Curve HNBB 1 amp D5LRS IL 30gtts/min -5 HNBB 1 amp Epidural anesthesia Nubain 5mg + Promethazine 25mg/IV Nubain 5mg + Promethazine 25mg/IV 10 -4 9 -3 -2 8 7 -1 6 0 5 +1 4 +2 3 +3 2 +4 1 +5 0 0 1 2 3 4 5 6 7 8 9 10 9pm 10 11 12 1am 2 3 4 5 6 7 11 .

Cephalic.Admitting diagnosis G2P1 (1001) Pregnancy Uterine 38 6/7 weeks AOG. in labor .

PLAN
 Awaits delivery

Patient Profile # 3 (Service)
SM, 26

G2P0
(0010)

Filipino

Angeles
city

CC: watery vaginal discharge




Few hours PTA

(+) Watery vaginal discharge
(+) hypogastric pain
(-) vaginal bleeding
(+) good fetal movement
• Consult

History of Present Illness

paternal (-) HTN (-) ASTHMA (+) CA.PAST MEDICAL • (-) HPN • (-) DM • (+) Asthma • Last attack : HS • (+) Allergy: Cefalexin • (-) Goiter • (-) hepatitis FAMILY HX (+) DM. Drinker • Catholic • Vocational graduate • Cashier • Married – 6 mo .breast Camaternal • (-) heart disease • • • • P AND S HX • (-) Smoker • (-) Alcoholic bev.

complete miscarriage  G2: PP  LMP: 01/03/2014  EDC: 10/10/2014 .Obstetrics History  G2P0  G1 : 2008. 1 mo.

Gynecologic History M=13 Y/O I= Regular. 28 day cycle D= 3-4 DAYS A= 4-5 PPD/MODERATELY SOAKED S=(+) DYSMENORRHEA 1st SC: 17 #SP: 4  (-) OCP use  (-) Post-Coital Bleeding  (-) Dyspareunia  (-) Pap Smear .

coherent. conscious. BMI= 24. BMI= 19. gain: 13 kg .PHYSICAL EXAMINATION  General: awake.6 kg/m2  Wt. not in cardio-respiratory distress  Vital signs:  BP: 120/80 PR: 88 RR: 19 Temp: 36.7 kg/m2  Current Weight: 65 kg.6oC  Height: 5’4”  Previous Weight: 52 kg.

(-) murmur. (-) retractions. anicteric sclerae  Lungs: symmetrical chest expansion. clear breath sounds  Heart: adynamic precordium.PHYSICAL EXAMINATION  HEENT: pink palpebral conjunctivae. normal rate and rhythm .

engaged) LM4: head descent. Station -2 (1) Bishop score: 6 . round non-ballotable structure (cephalic. + striae  FH: 34cm FHT 140s EFW: 3410 gm Leopold’s maneuver: LM1: large. cephalic prominence on the opposite side of the fetal back IE: Cervix 3 cm dilated (2). 50 % effaced (1). irregular mobile parts on the left maternal side LM3: hard. soft (2). posterior position (0). cephalic. non tender. (-) BOW. nodular mass occupies the fundus (breech) LM2: hard resistant structure on the right maternal side.PHYSICAL EXAMINATION  Abdomen: globular.

Montevideo units: 250 . strip.Initial CTG B FHT: 145-150s. UC: moderate contractions every 2-3 minutes in a 20 min. (-) decelerations. (+) accelerations. minimal-moderate variability.

D5LRS IL + 10 ‘u’ Oxytocin 10 gtts/min -5 10 -4 9 -3 -2 8 7 -1 6 0 5 +1 4 +2 3 +3 2 +4 1 +5 9 0 pm 10 11 12 1 amp HNBB 1 amp HNBB .

GDM . Cephalic. in labor.diet controlled .Admitting diagnosis G2P0 (0010) PU 39 6/7 weeks AOG.

PLAN  Awaits delivery .

BW 2.Final Diagnosis  G2P0 (0010) PU term cephalic delivered via NSVD live birth baby boy. BL : 51cm.diet controlled .9 NMR 39 weeks AGA. thickly meconium stained amniotic fluid.94kg. AS 8. GDM .

27 G1P0 Filipino Angeles city CC: Watery vaginal discharge .Patient Profile # 4 IT.

• • • • Few hours PTA (+) watery vaginal discharge (-) vaginal bleeding (-) hypogastric pain (+) good fetal movement • Consult History of Present Illness .

Drinker • Born again • Vocational graduate • Technician • Married .paternal (+) HTN.PAST MEDICAL • • • • • • (-) HPN (-) DM (-) Asthma (-) Allergy (-) Goiter (-) hepatitis FAMILY HX • • • • • (+) DM.paternal (-) ASTHMA (-) CA (-) heart disease P AND S HX • (-) Smoker • (-) Alcoholic bev.

Obstetrics History  G1P0  G1 : Present Pregnancy  LMP 1/7/14  EDC 10/14/14  AOG 39 2/7 .

Gynecologic History M=12 Y/O I= Regular. 28 day cycle D= 4-5 DAYS A= 4-5 PPD/MODERATELY SOAKED S=(-) DYSMENORRHEA 1st SC: 26 #SP: 1  (-) OCP use  (-) Post-Coital Bleeding  (-) Dyspareunia  (-) Pap Smear .

7 kg/m2  Current Weight: 157 lbs. BMI= 26.6oC  Height: 5’4”  Previous Weight: 132 lbs.PHYSICAL EXAMINATION  General: awake. conscious.9 kg/m2  Wt. coherent. BMI= 22. gain: 25 lbs . not in cardio-respiratory distress  Vital signs:  BP: 120/80 PR: 88 RR: 19 Temp: 36.

PHYSICAL EXAMINATION  HEENT: pink palpebral conjunctivae. clear breath sounds  Heart: adynamic precordium. anicteric sclerae  Lungs: symmetrical chest expansion. (-) retractions. normal rate and rhythm . (-) murmur.

cephalic. soft (2). irregular mobile parts on the left maternal side LM3: hard. (+) BOW. 50 % effaced (1). engaged) LM4: head descent.PHYSICAL EXAMINATION  Abdomen: globular. + striae  FH: 34cm FHT 140s EFW: 3410 gm Leopold’s maneuver: LM1: large. nodular mass occupies the fundus (breech) LM2: hard resistant structure on the right maternal side. Station -2 (1) Bishop score: 6 . non tender. posterior position (0). round non-ballotable structure (cephalic. cephalic prominence on the opposite side of the fetal back IE: Cervix 3 cm dilated (2).

strip. (+) accelerations. (-) decelerations. Montevideo units: 200 . UC: moderate contractions every 4-5 minutes in a 20 min. Moderate variability.Initial CTG B FHT: 130-135s.

Nubain 5mg + Promethazine 25mg/IV D5LRS IL + 10 ‘u’ Oxytocin 10 gtts/min -5 10 -4 9 -3 -2 8 7 -1 6 0 5 +1 4 +2 3 +3 2 +4 1 +5 12pm 1 0 2 3 1 amp HNBB 4 5 6 1 amp HNBB .

in labor . Cephalic.Admitting diagnosis G1P0 PU 39 2/7 weeks AOG.

PLAN  Awaits delivery .

BL 48cm AS 8.Final Diagnosis G1P1 (1001) PU Term cephalic delivered via NSVD.9 NMR 39 weeks AGA.89 kg. Single nuchal cord coil . LBBB BW 2.

22 G1P0 (0010) Filipino Catholic Mabalacat CC: Vaginal bleeding .Patient Profile # 3 KA.

5 weeks PTA 2 weeks PTA • • • • (+) Vaginal bleeding with clots (+) consult was done TVS: thickened endometrium D&C was done • (+) Vaginal bleeding. 3-4 ppd • No consult History of Present Illness .

Few hours PTA • Persistence of vaginal bleeding • Consult at another PMD • Advised admission History of Present Illness .

PAST MEDICAL • • • • • (-) HPN (-) DM (-) Asthma (-) Allergy (-) Goiter FAMILY HX • • • • • (-) DM (-) HTN (-) PTB (-) ASTHMA (-) Breast P AND S HX • (-) Smoker • (-) Alcoholic bev. drinker • Single • INC • Highschool undergraduate • Unemployed .

Obstetrics History  G1P0 (0010)  G1 2014. 4 months AOG. evacuated by D&C. Private hospital .

30 days cycle D= 3-4 DAYS A= 8 PPD/MODERATELY SOAKED S= (-) DYSMENORRHEA 1st Sexual Contact: 17 Number of Sexual partners: 3  (-) OCP  (-) Post-Coital Bleeding  (-) Dyspareunia  (-) Pap Smear .Gynecologic History M=13 Y/O I= Regular.

not in cardio-respiratory distress  Vital signs:  BP: 110/70 PR: 72 RR: 18 Temp: 36. conscious.3  Height: 5’  Current weight: 39kg  BMI 17 kg/m2 (Underweight) .PHYSICAL EXAMINATION  General: awake. coherent.

PHYSICAL EXAMINATION  HEENT: pink palpebral conjunctivae. anicteric sclerae  Lungs: symmetrical chest expansion. non tender  Extremities: full and equal pulses. (-) murmur. normal rate and rhythm  Abdomen: Flabby. NABS. clear breath sounds  Heart: adynamic precordium. (-) edema . (-) retractions.

smooth. non tender SE: cervix pink. (-) erosions.PHYSICAL EXAMINATION  Abdomen: Flat. (-) active bleeding IE: cervix closed  Extremities: full and equal pulses. (-) edema . soft. NABS.

2014 .Admitting diagnosis G1P0 (0010) Abnormal Uterine Bleeding s/p D&C September 4.

Blood typing Tranexamic acid 1g/IV .Plan IVF: D5LRS 1L x KVO For CBC.

31 Catholic G3P2 (2012) Angeles City Filipino CC: Prolonged menses .Patient Profile # 4 PA.

TVS: thickened endometrium • Scheduled for D&C History of Present Illness .2 weeks PTA 1 day PTA • (+) Vaginal bleeding. 3-4 ppd • (-) Hypogastric pain • No consult • Persistence of vaginal bleeding • Consult done.

PAST MEDICAL • • • • • (-) HPN (-) DM (-) Asthma (-) Allergy (-) Goiter FAMILY HX • • • • • (-) DM (-) HTN (-) PTB (-) ASTHMA (-) Breast P AND S HX • (-) Smoker • (+) Occ. alcoholic bev. drinker • Single • Catholic • College graduate • Call center agent .

4. Private hospital. (-) complications. 6. evacuated by D&C. FTBG. FTBB.Obstetrics History  G3P2 (2012)  G1 2004. 3 months AOG. alive  G3 2008. alive .6 lbs. (-) complications. Private hospital. CS I x fetal distress. CS II x repeat.6 lbs. Private hospital  G2 2004.

normal .Gynecologic History M=13 Y/O I= Irregular. 28 days .3 months D= 3-4 DAYS A= 3 PPD/FULLY SOAKED S= (-) DYSMENORRHEA 1st Sexual Contact: 18 Number of Sexual partners: 1  (-) OCP  (-) Post-Coital Bleeding  (-) Dyspareunia  (+) Pap Smear – 2008.

9 kg/m2 .3  Height: 5’5”  Current weight: 162 lbs  BMI 36.PHYSICAL EXAMINATION  General: awake. not in cardio-respiratory distress  Vital signs:  BP: 130/90 PR: 84 RR: 19 Temp: 36. conscious. coherent.

normal rate and rhythm  Abdomen: Flabby. non tender  Extremities: full and equal pulses. (-) edema . (-) murmur. (-) retractions. anicteric sclerae  Lungs: symmetrical chest expansion. clear breath sounds  Heart: adynamic precordium.PHYSICAL EXAMINATION  HEENT: pink palpebral conjunctivae. NABS.

Admitting diagnosis G3P2 (2012) Abnormal Uterine Bleeding T/C Endometrial Pathology .

Plan Dilatation and Curettage .

Thank you .