CASE PRESENTATION

MODERATOR : DR TEJASWINI K K
PRESENTER : DR BHARATI
• NAME : Mrs. X
• Age :32years
• Occupation : Home maker
• Education : 12th Standard
• Husband’s name : Mr X
• Age : 36years
• Occupation : Auto driver
• Eduction : 10th standard
• Address : Bellandur Bangalore
• Socioeconomic status : lower middle class according to kuppuswamy
classification
• Date of admission : 7/12/2022 1.30PM
• Date of examination :7 /12/2022 4.30 PM
 G3P2L2 with 9 months of amenorrhoea
 LMP – 12/03/2022
 EDD – 19/12/2022
GA – 38+2weeks

G3P2L2 with 9 months of amenorrhea referred from Tavarkere GH

i/v/o twin pregnancy.
History of presenting illness
G3P2L2 with 9 months of amenorrhea , C/O Pain abdomen since 6
hours.
Pain was insidious in onset gradually progressive and was increasing in
intensity and frequency. The pain radiates to medial part of thighs and
lower back.
Perceiving fetal movements well.
No h/o leaking PV, bleeding PV.
No history of headache , vomiting, epigastric pain, blurring of vision,
decreased urine output , swelling of lower limbs.
No h/o burning micturition, increased frequency of micturition.
 Obstetric History

 Married life : 12 years

 Non consanguinous marriage
 Obstetrics score : G3P2L2
 G1 – Uneventful. Full term vaginal delivery. Delivered an alive girl
baby of birth weight 2.6kg. 10years of age. Alive and healthy.
 G2- Uneventful. Full term vaginal delivery. Delivered an alive girl baby
of birth weight 2.9kg. 6years of age. Alive and healthy.
History of presenting pregnancy

 1st trimester-
 Booked case at Tavarakere GH

 Patient conceived spontaneously

 Pregnancy was detected by UPT at two and half months of amenorrhea at tavarakere GH

 It was confirmed by ultrasonography and was told to be twin pregnancy

 Blood tests were done and told to be normal

 Inj. Td was given at 2 and half months of amenorrhea

 T. Folic acid was taken.ab folic acid was taken.

HOPP continued….
• 1st trimester-
No history of
 Excessive vomiting
 fever with rash
 bleeding per vaginum,
 Burning micturition
 Radiation exposure
 No history of any other drug intake other than folic acid
• 2nd trimester:
Quickening felt at 5 month of pregnancy
 Tab Iron and Calcium taken once daily

 Injection Td 2nd dose taken at 5 months

 Ultrasound scan was done at 5th month and told to be normal.

 Blood tests were done at 5 MOA and told to be normal.

 No h/o pain abdomen, burning micturition

 No H/O excessive weight gain, headache, blurring of vision, epigastric pain, nausea,
swelling of lower limbs,
 No H/O bleeding PV.
3rd trimester-
• She continued to perceive fetal movements well
• Continued taking iron and calcium tablets regularly.
• Scan was done at 8 MOA and was told to be normal.
• No h/o headache, epigastric pain, vomiting, blurring of vision or lower
limb swelling.
• When she had gone to tavarkere GH with pain abdomen at 9 months
was referred to Vani Vilas hospital i/v/o DCDA twins.
Menstrual history
• Previous cycles- regular, moderate flow, no heavy menstrual bleeding
• LMP-12/3/22
Past history
 Not a known case of hypertension, diabetes mellitus, thyroid
disorders, tuberculosis, renal disease, cardiac disease, epilepsy ,
bronchial asthma
 No history of any drug allergies or blood transfusion.
 No history of any surgeries in the past
Family History
• No history of any hypertension, diabetes mellitus, tuberculosis,
genetic disorders in the family.
• No history of twinning and congenital anomaly in the family.
Personal History
 Diet : mixed
 Normal appetite
 Sleep: Normal
 Bowel bladder -regular
 No history of smoking/ alcoholism/ drug abuse
General physical examination
• Moderately built and moderately nourished,
• Pre pregnant weight- 54 kg; height- 158cm ; BMI-21.63kg/m2
• Present weight-71 kg
• weight gain- 17kg
• No Pallor, Pedal edema icterus, clubbing, cyanosis
• Breast, spine and thyroid – normal
General physical examination continued….
 VITALS
 Temperature- afebrile
 PR-88/min
 BP-110/70 mmHg
 Respiratory rate-16/ min
Systemic Examination
 Respiratory system- B/L normal vesicular breath sounds heard, no
added sounds
 Cardiovascular system- S1, S2 NORMAL, no murmurs
 CNS-No abnormality detected
Obstetric Examination

Inspection-
• Abdomen overdistended, flanks full
• Stria gravidarum and linea nigra present
• Umbilicus- central, everted.
• No visible scars or sinuses
• Hernial orifices appear normal
Obstetric examination continued
 Palpation-
 Uterus overdistended.
 Relaxed
 Fundal Grip – suggestive of head.
 Left lateral grip – suggestive of head.
 Right lateral grip- multiple fetal parts felt.
 1st Pelvic grip- suggestive of breech.
 2nd pelvic grip- converging fingers.
• Measurements
• SFH 38 cms
• Abdominal girth 42 inches

• Auscultation:
• Fetal heart sounds heard
• FHS 1-134bpm
• FHS 2- 146bpm
• Per vaginal examination:
• Cervix: Mid position , medium consistency
1cm dilated , 3cm long
presenting part at -3
membranes present
pelvis
sacral promontory not reached.
sacrum is well curved – above downwards and sideways
sacrosciatic notch – admitting 2 fingers
side walls parallel and divergent
interspinous diameter – adequate
subpubic arch and angle normal
transverse diameter of the outlet – admits four nuckles
Summary
• Mrs X aged 32 years, belonging to lower middle class is G3P2L2 with
38weeks 2 days period of gestation, was referred in view of DCDA
twins, presented with pain abdomen.
Provisional Diagnosis
G3P2L2 38weeks with 2 days period of gestation with live intrauterine
twin pregnancy with first twin in breech presentation not in labour.
INVESTIGATIONS
• Hb-11g/dL
• Total count-8,210cells/mm3
• PLATELET COUNT- 2.49lakh/mm3
• Blood group – O positive
INVESTIGATION CONTINUED
• Obstetric scan(28/09/2022)
TWIN 1 TWIN 2
BPD 7.6 cm 7.3 cm
EFW 1503 grams 1434 grams
PLACENTA Fundal posterior
PRESENTATION cephalic breech
AMNIOTIC FLUID 12.8 cm 12.4 cm
AVERAGE MATURITY 30 weeks 1 day 29 weeks 5 days

• Intrauterine live twin pregnancy, dichorionic and diamniotic type, with

mean gestation of twin 1 – 30weeks 1 day, twin 2 29 weeks 5 days.
THANK YOU