Case Study Presentation

Submitted By:
Parash Phuyal
General Medicine Third Year
Koshi Health Institute
BRT-1
SOCIO-DEMOGRAPHIC STATUS OF
PATIENT:

• Name: Aarati Shah

• Age:24
• Sex: Female
• Address: Jahada-2
• Religion: Hindu
• Occupation: Housewife
• Date Of Admission: 2079/3(Aashad)/10
• Husband’s Name: Binod Shah
Vital Signs at the time of admission

• Blood Pressure (BP): 130/90 mm of hg

• Pulse Rate(PR): 84 beat/minutes
• Respiration Rate(RR): 18 breaths/minute
• Temperature: 97.8°f
Clinical History

Menstrual History:
• Last Menstrual Period (LMP):2078/07/01
• Estimated Date of Delivery (EDD):2079/04/08
Past History: Present History:
• Medicinal History: No previous medicinal history • Vaginal Bleeding
• General state of health: Excellent • Vaginal Leaking
• Surgery: No surgical History • Fetus suddenly stopped moving and kicking
• Immunizations: TD (tetanus and diphtheria)
vaccine 2 times
Investigations:
CBC(Complete Blood Count)
USG(Ultra-Sonogram)
• WBC: 13300
• Fetal heart rate - NO CARDIAC ACTIVITY SEEN
• PBC: 3.95
• Liquor: Adequate (AFI ~ 16.9 cm, total 4 pockets) • Platelets: 3,99,000
• Fetal weight: 2612gms • HB: 11.6
• IMPRESSION ► Intra-uterine fetal demise (IUFD) • PCV: 34.8
corresponding to 35 weeks 2 days of gestational age
(based on femur length) in cephalic presentation.

HIV: Negative
HBsAg: Negative

RBS(Random Blood Sugar): 98

Urea: 16
Creatinine: 0.53
Provisional Diagnosis
G2 P1 L1 with 36 weeks and 2 days of POG (period of gestation)

Final Diagnosis
G2 P1 L1 with 36 weeks and 2 days of POG (period of gestation) with IUFD(Intra-uterine fetal death)
Introduction Of
•Disease/Problem
What Is Intrauterine Fetal Demise?

Intrauterine fetal demise (IUFD) is the medical term for a child who dies in
utero after the 20th week of pregnancy in the second trimester.
Although there is no agreed-upon time, most doctors deem the death to
be an IUFD if it occurred after 20 weeks of gestation. This is as opposed to
a miscarriage, which happens before the 20th week.

While the causes of IUFDs are not always apparent, there are certain
known risk factors that doctors can screen for, diagnose, and monitor
throughout the pregnancy.
IUFD Risk Factors 
While the cause of stillbirth is not always known, there are some known risk factors that have been linked to IUFD.
These include: 
• Diabetes
•Hypertension 
•Obesity
•Multiple gestations
•Advanced Maternal Age
•A history of pregnancy complications, like growth restrictions and preeclsmpsia
•Previous miscarriages or stillbirths
•Exposures during pregnancy such as alcohol use, smoking, and drug use
Some common causes of IUFD include:
• Placental Insufficiency.
• Placental Abruption.
• Fetal Infection.
• Genetic Abnormalities of the fetus.
• Congenital Anomalies of the fetus.
• Feto–maternal Hemorrhage (transfer of blood from the baby into the maternal circulation)
• Umbilical Cord Complications.

 Although there are some known causes and risk factors, many cases of second
trimester IUFD do not present classically, and a clear cause of IUFD
is not always found. in fact, in about half of all cases, the cause of stillbirth
is unknown. 
Daily Progress Note 

Admission Day
• Women with G2P1L1 with symptoms of vaginal bleeding and vaginal discharge arrived at the gyne
admission ward on 2078/03/10 at 36 WOG(Week of gestation). Her general condition was well
assessed. She was well oriented to time, place and person. Her OS was closed as per the per
vaginal examination.
In the doctors round it was instructed to start IOL(induction of labor) on her. Her vital signs and os
was both monitored from time to time.
Her medications for IOL was also started which consisted of Misoprostol 25 μgm 12 o’clock S/L
(SubLingual)
4 o’clock
8 o’clock
Day 1
• Women’s general condition was assessed. She was well oriented to the time, place and person.
She had some progress with her IOL. Her os was 3 cm . So doctor’s plan for her was to continue the
induction till tomorrow to see the progress.
Her vitals were closely monitored as well as her dilation of cervix.

Vitals at the time of 6 pm

BP: 100/60 mm of hg
Pulse rate: 78 b/m
Temperature: 97.4° f
Respiration rate: 22 breaths per minute
Day 2
• Women’s general condition was assessed. Her vitals at the time 6pm were

BP: 110/70 mm of hg
Pulse rate: 76 beat per minute
Temperature: 97° f
Respiration rate: 22 breaths per minute

Her os had dilated to 6 cm and the crowning phase had started at around 4 pm time. She was taken in
the delivery room where she birthed a stillborn baby. At the doctor’s round the doctor adviced to
continue to observe her till tomorrow when she would be discharged.
Discharge Day
• Women’s general condition was assessed. Her vitals at the time 6 pm were

BP: 110/70 mm of hg
Pulse rate: 84 beat per minute
Temperature: 98.4° f
Respiration rate: 18 breaths per minute

She was well oriented to time, place and person. Her condition was fine. At the round, the doctor
discharged her per the request of her guardians and as her condition was inproving.
Epidemology OF IUFD/Stillbirth
• In 2019, an estimated 1.9 million babies were stillborn at 28 weeks of pregnancy or later, with
a global stillbirth rate of 13.9 stillbirths per 1,000 total births

• The report reveals huge differences in stillbirth rates across the globe, with a risk that is up to
23 times higher in the worst affected countries. Stillbirths were concentrated in a few
countries, with the greatest number found in India, followed by Pakistan, Nigeria, the
Democratic Republic of the Congo, China and Ethiopia. These six countries accounted for half
of the estimated global number of stillbirths and 44 per cent of global live births.

• In Nepal the prevalence of stillbirth across three ecological zones indicates that the rate
was 28 per 1000 amongst mothers who resided in the mountains whereas this rate was 17
per 1000 in the terai, and 19 per 1000 in the hills.
Prevention Strategy of said disease/problem:
• Usually, a stillbirth cannot be prevented. It often occurs because the baby's development was not normal.
Helping improve the mother's health, including managing preexisting conditions and lifestyle choices, improve
the chances of a successful pregnancy.

• Go to all your antenatal appointments

It's important not to miss any of your antenatal appointments. Some of the tests and measurements that
can identify potential problems have to be done at specific times.

• Eat healthily and keep active

Try to swap unhealthy foods for healthier options, and try to keep active. Being overweight or obese can
increase the risk of problems in pregnancy.

• Stop smoking
If you smoke, the best thing you can do is to stop. Stopping at any time in pregnancy will help, though the sooner
the better.

• Avoid alcohol in pregnancy

The safest way to ensure your baby is not damaged by alcohol is not to drink while
you're pregnant. 
• Wash your hands
Be strict about good hygiene wherever you are. This includes washing your hands to reduce the risk of infection,
particularly:
1. before preparing food
2. after going to the toilet
3. after changing a nappy, if you already have children

• Tell your doctor about any drug use

If you use or have used street drugs (such as cannabis, cocaine, ecstasy or heroin) or other substances, tell your
midwife.
Learning Experience
Through this case study, I gained the knowledge of

• To identify what type of care the patient needs and ways to fulfill those needs.

• To study about a specific subject and provide others with the knowledge I gained.

• I got the opportunity to learn about/ and the ways to carry out investigations needed in order to diagnose said
problem.

• I was able to put my theoretical knowledge into a proper practical field.

• I got the knowledge to put together a case study properly and effectively.
 THANK YOU

Submitted By:
Parash Phuyal
General Medicine Third Year
 REFRENCES

https://www.nhs.uk/pregnancy/keeping-well/reducing-the-risk-of-stillbirth/

https://www.tommys.org/baby-loss-support/stillbirth-information-and-support/giving-birth-stillborn-baby

https://www.uptodate.com/contents/stillbirth-incidence-risk-factors-etiology-and-prevention

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-9-S1-S4

https://www.childbirthinjuries.com/birth-injury/intrauterine-fetal-demise/