Wednesday 4th December 2019.

Menatalla Hashem Abdelkader__

QUCMED – Corp no. 449989__
ma1512592@qu.edu.qa______
 Presenting Mrs. RB, gravida 4 parity 3 (previous
VD), a married 32-year-old Syrian housewife, She
was admitted as a case of GDM and SFD for
History induction of labor on the 28th of November at
39+5 weeks gestation (based off first trimester
USG)
History of Present Pregnancy:
Patient conceived spontaneously with no complaints on admission
1st Trimester: Confirmation of pregnancy was done at home with a urine pregnancy test, pre-pregnancy
weight was 70kg (BMI of 26.3kg/m2), booked at PHCC and started on folic acid supplements. USG was normal,
blood, sugar and urine exams and were also found to be normal she, however No Vaginal Bleeding , No
Excessive N/V, No LL swelling or Severe Headache

2nd Trimester: OGTT was performed and was Diagnosed with Gestational diabetes and has been on diet
control since– no BSS, anomaly scan was done and found to be normal, quickening noted at 5th month,
antenatal visits were at 4-week intervals, No Respiratory Problems , PPROM, Bleeding or Hemorrhoids

3rd Trimester: Upon 3rd trimester scan, fetus was found to be small for date by BPD and HC based on given
LMP, received consultation regarding maternal care for poor fetal growth and was set for admission for induction of
labor on the 28th of November. No signs of Preeclampsia, Preterm Labor, PROM, or Malpresentation.
Obstetric History:
• G4P3 with All deliveries being NVD here in Qatar
• Active married life: past 10 years, nonconsanguineous marriage
• History of using OCP’s & IUD use after 2nd pregnancy, then removed for 3rd
pregnancy
• Gravida 1: Weight: 3.350Kg Sex: F
• Complications (Antenatal): Hyperemesis gravidarum in first trimester
• Breast Feeding: Yes
• Gravida 2: Weight: 3.75Kg Sex: F
• Complications (Ante/Intra/Postnatal): None
• Breast Feeding: Yes
• Gravida3: Weight: 3.60Kg Sex: M
• Complications (Antenatal): Hyperemesis gravidarum in first trimester
• Breast Feeding: Yes
Gynecological History:
• She attained menarche at 14 years of age, mensural cycles are at intervals of 28 days . Lasting
for 4-5 days with regular, normal, painless flow and no intermenstrual bleeding.
• First Day of LMP:23/02/19 EDD according to LMP: 30/11/19
PMHx & PSHx : Unremarkable
Family History: Father diabetic and hypertensive , No family history of Pre-eclampsia, Preterm
birth, Chromosomal/ congenital anomalies
Drugs & Allergies:
• No allergies
• OP Meds:
• Calcium lactate 300mg (40 mg Ca) TAB, 300 mg, Oral, Daily, Not taking
• Ferrous Sulfate 190mg (60mg Fe) TAB, 190 mg, Oral, BID, Not taking
• Vitamin D2 1000 IU CAP, 1000 International unit, Oral, Daily, Not taking
Social History:
• Alcohol consumption/ Smoking/ Drug abuse: none
ROS:
• Intermittent constipation (last episode 2 days ago)
Physical Exam
General Exam:
A pregnant lady, slightly overweight in habitus, well nourished, conscious, co-
operative and well oriented to time place & person
Height: 163cm Weight: 83kg (13kg weight gain)
Vitals: 90BPM regular with good volume, 130/84 mmHg BP, afebrile
No pallor, icterus, edema, cyanosis, clubbing or lymph node enlargement
No thyroid enlargement seen
Breast examination is within normal limits
Systemic Exam:
Resp: Bilateral equal air entry, normal vesicular breathing present in all lung
fields
CVS: Audible S1+S2, no added murmurs, rubs or gallops
Physical Exam
Obstetric exam:
Inspection: uterus is longitudinally enlarged, everted umbilicus with evident linea
nigra & striae gravidarum, flanks not full & no scars over the abdomen. Intact
hernial orifices.
Palpation: uterus is 34 to 36 weeks sized, relaxed, symphyso fundal height is 36cm
• On fundal grip: soft, large, nonballotable mass is felt suggesting buttocks
• On left lateral grip: smooth, firm curve is felt suggestive of back
• On right lateral grip: irregular, knob like structures, suggestive of fetal limbs
• On pelvic grip: regular curved mass, suggestive of head, hands are converging below the presenting part
suggestive of a non-engaged head
-No hepatomegaly, splenomegaly or CVA tenderness, a single fetus with a longitudinal lie,
with cephalic presentation
-Fetal heart sound is present on the left spino umbilical line at a rate of 138 bpm & regular
-LL exam shows no edema, petechia and a normal dorsalis pedis pulse
USG OBSTETRIC 25/11/19
EDD by 1st Scan: 30.11.2019
GA by EDD from 1st Scan: 39weeks 3days

Number of Fetus: Single

Presentation: Cephalic
Amniotic Fluid: AFI= 12.50
Placental Localization: Anterofundal away from OS
Cardiac Activity: FHR= 153 bpm

Measurements:
BPD: 8.89cm = 36 weeks
HC: 32.06cm = 36+weeks
AC: 34.25cm = 38+weeks
FL: 7.80cm = 39+weeks

US Gestation: 37weeks 4days

EDD by US: 11.12.2019
EFW: 3378 grams
Fetal growth is within normal by AC and FL; ?Small for Date by BPD and HC based on given LMP.
Internal OS is intact.
Assessment G4p3 39+5 weeks GDD for IOL with SFD baby for
sweeping and insertion of PGE2 3mg tablets and
& Plan reassessment in 8 hours with CTG monitoring
and elastic stocking application