ANTENATAL

CASE
PRESENTATION
 SUMMARY:

A 30 year old female Mrs.Subhasini from

Melapalayam,a primi gravida belonging to a
nuclear family of upper lower socioeconomic
status is admitted in TVMCH with PIH
complicating pregnancy.
 PATIENT’S DETAILS:
• NAME : Mrs.Subashini
• AGE : 30 years
• GENDER : Female
• OCCUPATION :House-wife
• ADDRESS : New No:1,
Old No:651c1,
Bangalapa Nagar 3rd street,
Melapalayam.
• RELIGION : Hindu
• CASTE : SC
• CONTACT NO :785100104
• NEAREST HEALTH FACILITY: Melapalayam PHC
-15 mins by walk
• OBSTRETIC FORMULA : G1P0L0A0
• LMP :4/12/2016
• EDD :11/9/2017.
 FAMILY DETAILS:
S.No NAME AGE/ RELATION EDUC OCCUPA INCOME HEALTH
SEX TO HOF A- -TION STATUS
TION

1. Manivannan 31/M HOF 7th Coolie 250/day Normal

2. Subashini 30/F Wife 7th _ _ Normal

3. Kanagamani 53/F Mother _ _ _ Normal

FAMILY TREE
 SOCIO ECONOMIC HISTORY
• TYPE OF FAMILY : Nuclear family
• NO. OF MEMBERS : 3
• PERCAPITA INCOME:7500/3=Rs.1500
• According to modified Kuppusamy scale,
Education : 2
Occupation : 1
Family income : 3
Total score : 6
• The family belongs to Upper Lower class
 CHIEF COMPLAINTS:
• Admitted in TVMCH as referred from
Melapalayam PHC for the complaint of
increase in Blood Pressure and for the safe
confinement of pregnancy.
HISTORY OF PRESENTING COMPLAINTS
• H/O 8 months Amenorrhoea
• H/O Bilateral pedal edema for past 2 months
-pitting in nature
-confined to the ankle and feet
-relieved by rest
• No H/O vomitting
• No H/O epigastric pain
• No H/O Oliguria
• No H/O burning micturition
• No H/O headache/giddiness
• No H/O breathlessness
• No H/O palpitation
• No H/O bleeding PV
• No H/O blurring of vision
 HISTORY OF PRESENT PREGNANCY:
• DIAGNOSIS:
Confirmed at a private hospital in Chennai
two months after LMP by Urine pregnancy test.
• REGISTRATION:
 Registered at Melapalayam PHC during
second month of pregnancy.
 AN card is maintained
 No. Of AN visits -5
 I TRIMESTER:
st

•H/O nausea and excessive vomiting for 3 months.

•H/O fatigability.
•H/O fever:
-Low grade
-Not associated with rash
-Intermittent in nature for 1 month.
•Folate supplementation given
• No H/O pedal edema
• No H/O Oliguria/burning micturition.
• No H/O bleeding PV / discharge
• No H/O radiation exposure.
• No H/O drug intake
• Prenatal advices given.
• Investigations done:
Blood group : B positive
Hb : 11.6 g/dl
BP : 120/80 mm Hg
USG : Taken at 3rd month.
Urine albumin / sugar :nil
HIV , VDRL , Rapid malaria test : negative
 II Trimester:
nd

• No. of ANC visits: 3

• Quickening felt at 5th month.
• Iron folic acid tablets taken regularly.
-Total of 100 tablets
-Once daily
-No side effect seen.
• Ist dose of TT given during 4th month.
• No H/O breathlessness or palpitation.
• No H/O excessive tiredness.
• No H/O headache.
• No H/O blurring of vision.
• No H/O bleeding PV /discharge.
• No H/O bowel disturbances.
• No H/O pedal edema /puffiness of face.
• INVESTIGATIONS DONE:
Urine albumin/Sugar : Nil
Hb : 11.4 g/dl
BP : 134/80 mm Hg
USG : taken at 5th month.
Weight gain : 4 kg.
 III TRIMESTER:
rd

• No. OF ANC VISITS : 2

• H/O white discharge for the past 1 month.
• H/O burning micturition for past 2 days.
• IInd of TT given at 7th month.
• No H/O difficulty in sleeping/breathing.
• No H/O bleeding PV / abdominal pain
• Normal foetal movements felt.
• Weight Gain:4 kg.
BP : 145/90 mm Hg [7th month]
 HEALTH SEEKING BEHAVIOUR:
• Regular AN visits attended.
• Awareness about warning signs present.
• Health education given by Medical Officer in
PHC.
• Gender preference : None.
 MENSTRUAL HISTORY:
• Attained menarche at 12 years of age.
• Cycle
- regular with 3 days of moderate flow
associated with pain during periods.
 MARITAL HISTORY:
• Age at marriage : 29 years.
• Duration of married life : 10 months .
• Non-consanguineous marriage.
• No H/O contraceptive usage.

OBSTRETIC HISTORY:
• No previous obstretic history.
 PAST HISTORY:
• No H/O previous Hypertension.
• No H/O Diabetes mellitus.
• No H/O Tuberculosis/Jaundice.
• No H/O Epilepsy / Asthma
• No H/O Renal diseases.
• No H/O Blood Transfusion.
• No H/O previous surgeries.
• No H/O thyroid disorders.
 PERSONAL HISTORY:
• Has a normal appetite.
• Takes non-vegetarian diet.
• Normal bladder and bowel habits.
• Personal Hygiene:
Brushing teeth and bathing - once daily .
Cutting of nails -once a week.
• Has practice of wearing chappal.
• Has practice of hand washing before every
meal.
• No H/O afternoon sleeping.
• No H/O carrying heavy weights.
• No H/O drug intake/radiation exposure.
• No addictions.
 OCCUPATIONAL HISTORY:
• Non-working woman.
• Helps in household works like cleaning,
washing clothes.
 FAMILY SUPPORT:
• Supported by husband
• Accompanied to hospital visits by mother.
• Doesn’t experience marital discord/conflicts/
domestic violence.

FAMILY HISTORY:
• No similar condition seen in mother and sibling.
 DIETARY HISTORY:
24 hours dietary recall method
• TYPE OF DIET : mixed.
TIMINGS FOOD QUANTITY CALORIE PROTEIN

BREAKFAST IDLI 3 225 6

SAMBHAR 1 cup 110 10
MID MORNING _ _ _ _

LUNCH RICE 2 cups 340 10

KEERAI 1 cup 150 2
SAMBHAR 1 cup 110 10
EVENING MILK 1 mug 180 8

DINNER IDLY 3 225 6

SAMBHAR 1 cup 110 10
 ACTUAL INTAKE RECOMMENDED DEFICIT/EXCESS
(FOR PREGNANCY Addl)

CALORIE INTAKE 1450 2330 850 (deficit)

PROTEIN INTAKE 62 78 16 (deficit)

FRUITS AND VEGETABLES CONSUMPTION DAYS AMOUNT

NO. OF DAYS IN A WEEK – EATING VEGETABLES 6 1 cup/day

FRUITS NOT CONSUMED

• SALT INTAKE : 6 grams/day
• Commonly used oil : Groundnut oil
• Fast food intake : None
• Fried food intake : None
• Habit of eating outside : Nil
• Food beliefs present
• No other customs observed in the family
• Didn’t utilise Anganwadi services.
 ENVIRONMENTAL HISTORY:

• HOUSING:
Semi-pucca house - rented
No. of living rooms :2
No. of persons residing : 3
No overcrowding.
• LIGHTING:
Adequate
• VENTILATION:
No. of windows : 2
Adequate ventilation present.

• COOKING PLACE:
separate / indoor
Cooking fuel : Firewood
Smoke vent present
• METHODS OF WASTE DISPOSAL:
Solid waste - Street dumps
Waste water - to sewage

• TOILET FACILITIES:
Separate sanitary latrine present
No open air defecation.
• DRINKING WATER SUPPLY:
Source : Municipal water supply
Frequency :Daily 3 hours
Storage : in vessels and drums
No boiling of water
No household purification methods.
• No animals or pets.
• Mosquitos present
No control measures followed
• Cleanliness of surrounding areas:
Breeding areas present.
 ECONOMIC CONDITIONS:
• Total Family Income: Rs.7500/month
• Savings/Debts : Nil
• Loans/Interest: Nil
• Ration card : Colour - Green
Services - all government
provided subsidised food and
fuel utilised.
• Appliances : Television - present
Fan - present
Mixie - not present
Grinder - not present
• Family tension due to economic condition
present.
 CUSTOMS OBSERVED:
Valagappu ceremony done.

BIRTH PREPAREDNESS:
• Place of delivery decided(TVMCH)
• Mother and Husband to accompany her to
hospital.
• Arrangement for blood donors not done.
 KNOWLEDGE ASSESSMENT
KNOWLEDGE OF YES/NO

• Prelacteal feeds No
• Importance of breast feeding Yes
• Duration of breast feeding No
• Supplementary feeding No

• Immunization Yes

• Family planning Yes

No
• Spacing methods No
• Permanent sterilization methods
GENERAL PHYSICAL EXAMINATION:
• Patient moderately Built
moderately nourished
conscious
oriented , afebrile
• No Pallor
• Not Icteric
• No Cyanosis
• No Clubbing
• No Generalized lymphadenopathy
• PEDAL EDEMA : bilateral pitting pedal edema
confined to ankle and feet seen
• Tongue and oral hygiene : Normal
• JVP not seen

VITALS :
Pulse rate : 67/min
BP : 140/90 mm Hg
Respiratory rate : 16/min
 ANTHROPOMETRY
• Height : 142 cm
• Weight : 63 kg Before pregnancy : 56 kg
Weight gain of 7 kg present.
• Thyroid : No swelling
• Breast examination : No nipple inversion
No swelling/ soreness/ tenderness

• No spinal deformity
• Varicose vein : Nil.
 ABDOMINAL EXAMINATION:
• Inspection:
Abdomen uniformly distended
Linea nigra present
Striae gravidarum present
Umblicus in midline , flushed with skin
Hernial orifices - free
No visible scars
No engorged veins seen.
 PALPATION:
• Flanks –Free
• Fundal height:
midway between umbilicus and
xiphistenum.
correspond to 32 weeks of pregnancy
• Fundal grip :
soft , round ,broad , palpable mass felt
probably breach
• Umbilical grip:
- multiple nodules felt on left side
probably limbus
- uniform on right side
probably spine
• 1st pelvic grip:
hard, round, independent ballotable mass
felt, probably head
• Type of Presentation : Cephalic presentation.
• AUSCULTATION:
- Foetal heart sounds heard in the spino-
umblical line on the right side of abdomen.
- Rate : 125/min
• OTHER SYSTEM EXAMINATION:

CVS - S1 , S2 heard . No murmur

RS - Normal vesicular breath sounds heard
CNS - No focal neurological deficit.
 PROVISIONAL DIAGNOSIS:
30 year old primi gravida with 8 months of
amenorrhoea with EDD on 11/9/2017 has been
diagnosed as PIH with single live foetus in vertex
position with normal FSH.
LAB INVESTIGATIONS TO BE DONE
• Complete Urine Analysis (proteinuria)
• Blood sugar
• Complete Blood count - Hb , PCV , WBC-DC , TC , platelet
count , RBC count.
• Serum creatinine
• Serum sodium and potassium levels
• Lipid profile
• Routine examination of fundus oculi
• LFT and coagulation profile
• ECG , X-ray chest
FINAL CLINICOSOCIAL DIAGNOSIS:
A 30 year old primi gravida from
Melapalayam , with 8 months of amenorrhoea ,
belonging to upper lower socioeconomic class
has been diagnosed with PIH as complication
and is admitted in TVMCH for safe confinement
of pregnancy.
 ADVICE:
• Good nutrition
• Avoid jerky travels
• Don’t stress by lifting heavy weight
• Take green leafy vegetables and fruits
• Avoid salty and oily foods
• Continue iron folic acid tablets
• Maintain personal hygiene
• Take afternoon sleep
• Avoid self medications
• In case of danger signals, immediately consult the
physician