Case Presentation

OB/GYN

Ramie Alsaeidi
Hamza Afaq
History
Chief Complaint
A 28 years old married Saudi female medically free Primigravida, following up with
the OPD for her antenatal care, was admitted for induction of labor due to
asymmetrical IUGR with slightly raised doppler values of umbilical artery
LMP 29/12/2020, EDD 1/10/21 by U/S by Date 6/10/21, GA 38 weeks +5 days
Review of Systems
Review of systems is unremarkable and she does not have any symptoms
History
Obstetric History
Married, first pregnancy
Gynecological History
Menarche: age 12
Cycles are irregular, patient complains of hypomenorrhea with a short period for 3-
4 months prior to her pregnancy, with mild vaginal bleed for 3 days, not associated
with any clots or odors. No intermenstrual bleed, or dysmenorrhea.
Doesn’t use any contraceptives
History
Past Medical: Asthmatic on Ventolin inhaler, abnormally elevated TSH 1 year ago that
normalized 4 months ago, GBS status –ve
Past Surgical: Tonsillectomy, No history of blood transfusions
Past Medication: Ferose F 100mg, Pregnacare advanced capsule
Family History: DM, Asthma, Congenital cardiac disease
Social History: Consanguinity +ve she is married to her cousin, Has a regular diet,
sedentary lifestyle, non-smoker, non-alcoholic, no pets at home, hasn’t travelled
recently
No known allergies, All vaccines up to date
Physical Exam
General Physical Exam
Pallor: mild
Vitals (ADD)
Icterus: Absent
HR: 102
Cyanosis: Absent
BP: 111/55
Clubbing: Absent
RR: 19
Koilonychia, Leukonychia: Absent
Temp.: 36.7

Height: 142 cm Edema: Absent

Weight: 58.5 kgs Abdomen: soft and tender, presence of bowel sounds, Symphysial fundal
height going with GA , Longitudinal lie, cephalic presentation, +ve Fetal heart
BMI: 29.0
Vaginal exam: propess in posterior fornix still insitu, Os 3cm, effacement 60%,
Patient was conscious, alert, oriented membrane intact
but was uncooperative
CVS: S1 S2 heard, no murmurs

Chest: equal air entry bilaterally, with vesicular breathing

Investigation Urinanalysis
Glucose Negative
CBC 19/9/21
Labs Protein Trace
Bilirubin Negative
WBC 9.8 Urobilinogen Normal
NEU 64.1 PH 6.5
MONO 5.3 Blood negative
LYM 29.2
EOS 1.2 Ketone Negative
BASO 0.20 Nitrite Negative
RBC 4.5
HGB 11.8 Leukocytes Negative
HCT 36.70 Clarity Clear
MCV 81.40
MCH 26.20 Specific Gravity 1.02
MCHC 32.20 Color- Yellow
PLT 273
RDW 15.3% RBCs 0-2/ HPF
BASO
EOS
0.02
0.12
WBCs- 0-2/ HPF
LYM 2.86 Epithelial cells- Rare
MONO 0.52
NEU 6.28

Coagulation profile
APTT 27 sec  
PT 13.20sec  
s
e
c
INR 0.97  
Investigation
Imaging
U/S (18/9/21)
● Single viable fetus cephalic in presentation
● ESA 35 weeks +4days
● EFW is 2564 +/- 374g
● Regular cardiac pulsation
● HR is 134 BPM
● Placenta is upper posterior
● Amniotic fluid index= 9cm ( within lower limits of normal)
● Doppler values of umbilical artery are slightly raised
SD 3.1, PI 1.1, RI 0.6

 
GA according to given LMP is 38 weeks + 4 days, As abdominal circumference is smaller than expected gestation age in
nearly 3 SD with slightly raised doppler values of umbilical artery  Picture of asymmetrical IUGR
Management
● Patient was admitted for induction of labor with a propess inserted in her posterior vaginal fornix, with
close observation of the CTG, and progress of labor, with continuous hydration RL 500 ml + Gynocin
5iu started at 6ml/hr at 2:50 am today with sedation.

● CTG was reactive with moderate irregular contractions

● Delivery note:
uncooperative patient moving up from the bed,
Pt in lithotomy position, cleaned and drapped
NVD of alive baby boy weight: 2.4kgs, APGAR score: 8/9
Placenta and membrane delivered completely
Right mediolateral episiotomy done, repaired by vicryl 0 abd 2-0
Uterine atony thus massage was done and uterotonic agent was give.