A CASE OF ANAEMIA

COMPLICATING PREGNANCY

DR.KALAIVANI,MD.,DGO.DNB
SUPERINTENDENT &
PROFESSOR OF OBS AND GYN
GOVT RSRM LYING IN HOSPITAL
STANLEY MEDICAL COLLEGE
 Mrs. Vijaya Lakshmi 19 years Housewife belonging to Class IV
socioeconomic status PRIMI Booked and Immunised
 LMP 18/1/2018
 EDD 25/10/2018
 With H/O 9 months of amennorhoea
 Referred from BUDHUR PHC as Anaemia Complicating
Pregnancy
CHIEF COMPLAINTS
C/O Breathlessness on exertion for the past 1 month
H/O PRESENTING ILLNESS
H/O Breathlessness on exertion for the past 1 month
Gradual in onset
H/o easy fatiguabiity
No h/o chest pain or palpitation or swelling of legs
No h/o reduced urine output
No h/o paroxysmal nocturnal dyspnoea or orthopnoea
No h/o lower abdominal pain
No h/o draining p/v or bleeding p/v
MENSTURAL H/O
 Attained menarche at 13 yrs of age
 5/30 days cycle, Regular
 Changes 2-3 pads per day
 No h/o dysmennorhea or menorrhagia

MARITAL H/O:
 Married since 2 years/ NCM
 Conceived spontaneously
 No h/o any contraceptive usage.
OBSTETRIC H/O:
PRIMI GRAVIDA
FIRST TRIMESTER:
 Pregnancy confirmed at 2 months of amenorrhoea by UPT at near by pvt hospital.
 Dating scan not done.
 No h/o folic acid intake
 No h/o morning sickness or fever with rash or any other drug intake or radiation
exposure.
 No h/o burning micturition.
SECOND TRIMESTER:
 Quickening felt at 18 weeks.
 Anomaly scan done
 Immunised 2 doses of TT
 OGCT was normal.
 H/O irregular intake of iron and folic acid.
 No h/o deworming
 No h/o bleeding p/v.
 No h/o blurring of vision, epigastric pain, vomiting, headache or reduced
urine output.
 No h/o breathlessness/easy fatigability or swelling of legs.

THIRD TRIMESTER:
 Able to perceive fetal movements well
 h/o irregular intake of iron and folic acid
 No h/o lower abdominal pain or draining p/v or bleeding p/v
 No h/o UTI symptoms.
 No h/o blurring of vision, epigastric pain, vomiting, headache or reduced
urine output
 h/o breathlessness on exertion since 8 months of amenorrhoea.
PAST HISTORY:
 h/o anemia treated with four doses of injection iron sucrose at budhur phc
at 7ma
for Hb value of 8.5gm/dl .patient had irregular visits following treatment .
Then she developed breathlessness on exertion and easy fatigability for which
she was referred to RSRM.
Not a known case of DM/ HTN/BA/THYROID /HEART DISEASE/
EPILEPSY / TUBERCULOSIS/ JAUNDICE
No h/o any blood transfusions/ drug allergy/ major surgery.
FAMILY HISTORY:
 No h/o haemoglobinopathies/ hereditary disorders/ DM/ HTN in family
members.
 PERSONAL HISTORY:
 Normal bowel and bladder habits
 No h/o any drug abuse.
 GENERAL EXAMINATION

ANTHROPOMETRY:
 Height 156 cm
 Pre Pregnancy Weight 45 kg
 Weight at present 50 kg
 Weight gain during pregnancy 5 kg ( not adequate)
 BMI 20.54
 O/E Pt afebrile
Thin built and moderately nourished
anemic
comfortable at rest
not dyspneic/ not tachypneic
JVP not elevated
not icteric
no cyanosis /clubbing
mild b/l pedal edema
no varicosities.
 VITALS:
Temp - normal
Pulse Rate – 90/min
Blood Pressure – 110/70 mmhg

BREAST – NORMAL
THYROID – NORMAL
SPINE – NO SCOLIOSIS

SYSTEMIC EXAMINATION:
CVS – S1S2 +
No murmurs
No added sounds
RS – B/L NVBS +
OBSTETRIC EXAMINATION:
INSPECTION:
 Abdomen longitudinally enlarged
 Flanks full
 Umbilicus flushed with surface
 Linea nigra seen
 Stria gravidarum absent
 No abdominal wall edema
 PALPATION:
 Symphysiofundal Height 36 cm
 Fundal height corresponds to term
 FUNDAL GRIP:
 Broad soft non independently ballotable mass felt probably breech
 UMBILICAL GRIP:
 Uniform smooth hard curved resistance felt on the right side probably back
 Multiple small nodules felt on the left side probably limb buds
 FIRST PELVIC GRIP:
 Hard round independently ballotable mass felt in the lower pole probably head
which is not mobile
SECOND PELVIC GRIP:
Findings of first pelvic grip confirmed
Head unengaged
 AUSCULTATION:
 Fetal heart sound heard below the umbilicus on the right spino umbilical
line.
 Fetal heart rate – 152/min normal in rhythm.

 SUMMARY:
19 years old Mrs. VIJAYALAKSHMI primi gravida housewife by occupation
belonging to class IV socioeconomic status booked and immunised with regular AN
visits with LMP 18/1/18EDD 25/10/18 with H/o 9 months of amenorrhoea
Referred from budhur phc as anemia complicating pregnancy with H/o
breathlessness on exertion and easy fatigability for the past one month, with
significant past history of anemia treated with 4 doses of injection iron sucrose. On
examination found to be anaemic, term pregnancy with cephalic presentation.