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CLINICOSOCIAL CASE:

ANTENATAL CASE
(as taken on 16 , 17 and 18 February 2017)
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By- Aditya Kumar Rout

Dept. of preventive and social medicine, JIPMER


SUBJECT PROFILE
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 Name - Mrs. Sharmila sundarmorthy
 Age/ Marital Status - 26years, married since
3years
 Address – Car street, thondamanattnam(Pondicherry), 40 mins
away from JIPMER (by bus)
 Educational Status – B.A.
 Occupation – Primary school Teacher at private school
 Name of the husband – Mr. Sundarmoorthy
 Monthly per capita income – Rs. 4750
 Socio-economic scale- Class II according to modified B.J.Prasad
scale
 Nearest Health facility – R.H.C, Ramnathapuram,
10 minutes
 Respondent – Self
Dept. of preventive and social medicine, JIPMER

 GPLA Score- G2 P1 L1
PRESENTING COMPLAINTS:
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Apparently all right till present date.
No complaints till date.

Dept. of preventive and social medicine, JIPMER


OBSTETRICS HISTORY
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 LMP: 01/11/16; EDD:08 /08/17; POG: 15 wks+4 days
 Conception - spontaneous.
 Pregnancy confirmed after 45 days of amenorrhea by Urine
Pregnancy Test by herself.
 Registration done in 2nd month.
1st Trimester 2nd
Trimester
No. of ANV 2 1

*ANV – Antenatal Visits; LMP – Last Menstrual Period;


EDD – Expected Date of Delivery; POG – Period of Gestation
Dept. of preventive and social medicine, JIPMER
1st Trimester
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1. No H/O bleeding p/v.


2. No H/O excessive vomiting during this period.
3. No H/O chronic drug intake. Folate tablets started from 1st trimester.
4. No H/O fever with rashes.
5. No H/O exposure to radiation.
6. USG Scan in done in 1st trimester on 30/12/2016.
it was a Single live intrauterine gestation(SLIUG) corresponding to POG
of 8 weeks and 3 days.
7. Tetanus booster given at 11 weeks of POG.

Dept. of preventive and social medicine, JIPMER


2nd Trimester
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1. Quickening – Not yet felt.


2. Iron and folic acid intake.
3. 7-8 hours of sleep at night.
4. No imminent symptoms of gestational
hypertension- oliguria, epigastric pain,
blurring of vision or headache.
5. No h/o of pedal edema.
6. No signs and symptoms suggesting of
gestational diabetes mellitus.

Dept. of preventive and social medicine, JIPMER


MENSTRUAL and MARITAL HISTORY
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 Menarche -14 years.

 Cycles – regular ,once in 30 days ,3-4 days of flow

 No H/O of dysmenorrhea.

 Married since 3 years; non consanguineous

 No use of any contraceptive methods.

Dept. of preventive and social medicine, JIPMER


PREVIOUS OBSTETRICS HISTORY
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1. Type of Delivery – Spontaneous Vaginal.
2. Place ,Length of gestation-Rajiv Gandhi
Hospital(Pondicherry) , 09 months.
3. Sex and weight : Male , 2.9 Kgs.
4. Cried immediately at birth.
5. No H/O Postnatal fever, foul smelling lochia ,
bleeding p/v.
6. Colostrum given after 30 mins of delivery.
7. No prelacteal feed given. EBF for 6 months.
8. Complementary feeding (idli, milk powder, cow’s
milk, mashed fruits etc. ) - after 6 months.
9. Immunized completed till date.
Dept. of preventive and social medicine, JIPMER
PAST HISTORY…
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 No history of surgery.
 No h/o of Tuberculosis.
 No h/o of STD.
 No history of co-morbidities like:
diabetes mellitus, hypertension, epilepsy,
bronchial asthma, tuberculosis, heart disease,
thyroid disorders.
 No history of allergy.

Dept. of preventive and social medicine, JIPMER


Personal history

• No H/O addictions of alcohol/tobacco/drugs.

• Normal bowel and bladder habits.

• Normal appetite.
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Dept. of preventive and social medicine, JIPMER


Family History
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Dept. of preventive and social medicine, JIPMER


ENVIROMENT
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1. Housing - presently lives in pucca house with single


room and separate kitchen.
2. Toilet facility- YES. It is used by all.
3. Source of drinking water – Packaged Mineral water
4. Storage - pot and steel utensil.
5. Waste disposal- proper disposal with dustbins.
Garbage trucks comes regularly.
6. Animals/pets – no pets.
7. Socio-economic scale- Class II according to Modified
B.J.Prasad scale 2016.

Dept. of preventive and social medicine, JIPMER


SOCIO ECONOMIC HISTORY
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 They actively interact in different activities and
functions in the community.no presence of any social
stigma.
 Total family income- Rs. 4750 pm
 expenses on diet, transport and medicines and
others- approx. Rs.2000-3000 .
 Savings or debts- Rs. 1000-1500.
 No family tensions due to the economic situation.

Dept. of preventive and social medicine, JIPMER


Dietary history:
Time Food Calorie(Kcal) Protein(g
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Morning Idli(4 no.) 280 2.2
Sambar (1cup) 50 15
Dosa(3 no.) 435 8.4
Chutney 83
Afternoon Rice (1 cup) 110 2.2
Vegetable curry(1 cup) 170 0
Egg 90 13
Sambar(1 cup) 50 15
Night Idli(2 no.) 110 2.2
Dosa (2 no.) 50 15
Vegetable curry(1 cup) 170 0
Milk(1 glass) 67 3.2
Total 1935 70
Calorie intake Calorie required Calorie deficit
1935 Kcals 2250 Kcals 315 Kcals (14% )

Protein intake Protein requirement Protein deficit


Dept. of preventive and social medicine, JIPMER
70 g 75 g 5 g (7 %)
CLINICAL EXAMINATION
•comfortable at rest
•moderately built ,adequately nourished
•Afebrile
•pulse rate 90 beats per minute.
•blood pressure 99/62mm Hg
15 •respiratory rate 20 breaths / min
• Spine and Gait normal.

Dept. of preventive and social medicine, JIPMER


PICCLE
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 No pallor present.

 She is not icteric.

 There is no clubbing.

 There is no cyanosis.

 No B/L Pedal Oedema present.

Dept. of preventive and social medicine, JIPMER


17 ANTHROPOMETRY
 Height- 157 cms.

 Weight- 60 kgs.

 Symphysio-fundal height- 16 cms.

Dept. of preventive and social medicine, JIPMER


18 SYSTEMIC EXAMINATION
 Cardiovascular examination :
s1 and s2 sounds are heard.
no other added sounds heared.

 Respiratory examination :
RR is 20 br / min
normal bronchial and vesicular
sounds are heard
No abnormal respiratory sounds
heard.
Dept. of preventive and social medicine, JIPMER
Abdominal examination
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Inspection:
 abdomen is distended in the lower part.

 All quadrants move equally with respiration.

 Umbilicus is centrally positioned, not everted.

 stria gravidarum are faintly seen from the sides.


 Linea nigra could not be appreciated.
 Hernial orifices are free.

Dept. of preventive and social medicine, JIPMER


Palpation:
20  Fundal height : corresponds to 15th
week of gestation
 Symphysio-fundal height is 16 cms
(corresponds to period of gestation)
 A soft mass is palpable on the lower
quadrant of the abdomen.

Dept. of preventive and social medicine, JIPMER


Investigations done
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At RHC:
1.pregnancy detection test : done +ve
2.hemoglobin examination : done
Hb=11.4g/dl(current levels)
3. urine test for presence of
albumin and sugar done : absent
4.rapid malaria test : -ve

Dept. of preventive and social medicine, JIPMER


Investigations
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At RHC:
1. blood grouping : O+ve
2. VDRL : -ve
3. HIV test : -ve
4. rapid malaria : -ve
5. blood sugar profile : normal
6. HBs Ag for hepatitis B : -ve
7. GCT : 130 mg/dl

Dept. of preventive and social medicine, JIPMER


Provisional diagnosis
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Based on the history, examination and lab reports , we


conclude that she is Asymptomatic and progressing
towards a normal pregnancy and safe confinement.

Dept. of preventive and social medicine, JIPMER


Management
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At individual level:
1.Advised to take nutritious food. Especially about iron
rich diet
2. She is advised regarding danger signs of pregnancy.
3.Advice for institutional delivery.
4.Importance of exclusive breast feeding.
5.Importance of family planning.
6. Compliance to iron folate tablets.

Dept. of preventive and social medicine, JIPMER


Management
25 and interventions

 At family level:
1.supportive family members
2. Provide adequate diet and rest.
3. Accompany for regular follow up visits
4.Preparation for transport to health facility.

Dept. of preventive and social medicine, JIPMER


Management
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and interventions

At community level:
1. Regular counselling and home visits, early
identification of diseases and proper management
to be done.
2. Health education and Health promotion about
pregnancy management.
3. Education about post natal care and breast
feeding and care of new born.

Dept. of preventive and social medicine, JIPMER


Summary
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Provisional diagnosis-
26 years old, Mrs. Sharmila Krishnamoorthy with
G2P1L1 is in her 2nd trimester of pregnancy and
progressing to normal pregnancy and safe
confinement.

Dept. of preventive and social medicine, JIPMER


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Thank you 

Dept. of preventive and social medicine, JIPMER