 26 yr old lady

 Mrs A
 Primigravida with twin gestation at 8 months
amenorrhea
 Conceived by Ovulation induction with Letrozole
 Booked patient, belonging to socioeconomic class
II has come from kancheepuram for safe
confinement.
 LMP: 6/5/2018
EDD:10/2/2019.
 Menstrual history- 3/30-35 days, regular cycles,
normal flow
LMP: 6/5/2018 & EDD:10/2/2019.

 Marital history- 2 yrs, Non consanguineous

marriage.
No history of any contraceptive usage.

Obstetric history-
First trimester-
 conceived after ovulation induction,
confirmed by UPT at 50days of amenorrhea.
 no history of fever with rash, urinary tract infection,
drug intake, radiation exposure,
 Taken folic acid tablets regularly,
 Dating scan done revealed twin gestation
corresponding to dates,
 No history of excessive vomiting or spotting p/v.
 Second trimester -
3rd month scan was done and found to be
normal.
Quickening felt at 5 months of
amenorrhoea,
2 doses of Inj TT taken,
5th month scan was done and anomalies
ruled out,
No history of raised blood pressure.
OGCT was done and told to be normal.
Iron and calcium tablets taken regularly.
 Third trimester-
 8th month scan was done and growth was found to
be normal,
 repeat scan was done at monthly interval and found
to be normal.
 No history of bleeding or leaking p/v,
 perceives fetal movements.
 Past Medical history-No history of DM, HTN,
Tuberculosis, bronchial asthma, heart disease,
epilepsy.

 Past surgical history- No history of any surgeries

in the past.

 Personal history- Normal bladder and bowel

habits. Normal sleep and appetite, No history of
substance abuse.
 Family history- no history of twins in
maternal/paternal side.
 Height : 152 cm
 Pre pregnancy Weight: 64 kg
 BMI: 27.35
 Weight gain in pregnancy: 11 kg
 Moderately nourished and moderately built
 No pallor,
 bilateral pedal edema present.
 No varicose veins
 Thyroid : no enlargement
 Breast : normal
VITALS:
Temperature: afebrile
PR : 88 bpm
RR : 16 /min
BP :110/70 mm of hg in right upper
limb in sitting position
 CVS: S1,S2+
 RS : Normal vesicular breath sounds heard.
 CNS: No focal neurological deficit
 Abdominal examination:
Inspection: Abdomen over distended
Umbilicus – flushed to the surface
linea nigra and striae gravidarum
+,
No scars ,
Hernial orifices free
 Palpation-After taking consent and voiding
Symphysiofundal height-38 cm
Uterus corresponding to 36 wks
Relaxed
Three fetal poles palpable
clinically liquor normal.
 Fundal grip-
A broad, soft irregular mass felt in
right hypochondrium probably breech &
A hard, globular ballotable mass
felt in left hypochondrium probably head

Lateral grips: multiple fetal parts felt on both right and

left sides.

 First pelvic grip: A hard, globular, ballotable mass felt

probably cephalic.
 Auscultation: 2 Fetal heart sounds heard by two
examiners at same time
one in the right spinoumbilical line –
regular in rhythm, 140 bpm

second-just above the umbilicus towards left

side, regular in rhythm, 158 bpm
 Booked, 26 yr old primigravida at 36 wks +4
days, belonging to socio economic class II, EDD
corresponding to menstrual Gestational age,
ovulation induction conception, with twin
gestation, first twin being cephalic, with good
fetal heart rates, for safe confinement.