Case study– Obstetrics

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 Anita Roy

anita@gmail.com 9899720801

Irregular menses Gynaecology

Dr. D. Prasad

20 OCT 2007

21 OCT 2007

Patient logs into the

website or makes a
phone call for an
appointment
 SMS- 15 min delay
SMS- 30 min delay
SMS- 1 hr delay
SMS- 2 hr delay
SMS- 4 hr delay
SMS- 1 day delay

Patient given
reminder about the
appointment and
current status of the
queue on her mobile
 RBN20071021012 ROY O +VE

MRS HOUSEWI FE 17 NOV 1969

ANI TA
MARRI ED

C-56, FI RST FLOOR

2210221
ARDEE CI TY
997202225
NEW DELHI
ANI TA@GM
DELHI

110016

Patient gets a
DI LEEP HUSBAND
unique registration
number for all ROY 9972022251
subsequent visits
 Anita 31 yrs 11 mon 8 d Female OPD
Roy 1
-
-

Duration of present
complaint
Obstetrical and
menstrual History
Suspected pregnancy
3w
Past cycle 10-12 / 24-25 days Para 1 + 0. Last child age 3 yrs. 2 month amm

Mother with asthma

Family History

Past Medical & Surgical NA

History

Doctor takes the

80 98
entire history,
conducts systemic Per abdmonial examination shows a lump arising from the pelvis 8-10 week size. Per vaginal examination
shows uterus 14-16 week size mobile

examination, PA I rregular menses with bulky uterus suggestive pregnancy

and PV
 Anita 41 yrs 11 mon 8 d Female Room #6 B
Roy I rregular menses with pain in lower
1

Whole Abdomen
USG

Based on the
provisional diagnosis,
additional
investigations are
ordered using
templates
 Anita 41 yrs 11 mon 8 d Female Room #6 Bed #3
Roy I rregular menses with pain in lower ...
1

GENERAL EVALUATION:

Fetal Cardiac Activity: Normal a

141 BPM.
Fetal Lie: Longitudinal
Fetal Presentation: Cephalic
Placenta: Anterior, Grade II.
Uterus: Normal
Cervix: Closed
Adnexa: Not seen.
Amniotic Fluid: Normal
BIOMETRY:
BPD: 6.4cm consistent with 38
weeks, 2 days
HC: 33.1cm consistent with 37
weeks, 5 days
Pregnancy confirmed AC: 37.0cm consistent with 40
weeks, 6 days

after the USG – FL: 7.7cm consistent with 39

weeks, 3 days

radiology reports and CI (BPD/OFD): (70-86) 83

FL/BPD: (71-87) 82
FL/HC: (20.6-23.4) 23.3
images available to FL/AC (20-24) 21
HC/AC: (0.87-1.06) 0.89
doctor at her
computer
 Anita 41 yrs 11 mon 8 d Female Room #6 B
Roy Pregnancy 1st trimester. Routine investigations I rregular menses with pain in lower
1

Routine investigations
are ordered using
templates and results
compiled centrally
 Anita 41 yrs 11 mon 8 d Female Room #6 Bed #3
Roy I rregular menses with pain in lower
1

I rregular
Asthma menses with pain in lower abdomen
Asthma duringsince 21/04/2007
pregnancy
Excessive Since since
menstrual bleeding asthma is a very common disease affecting millions of people, it is not strange that lots o
18/10/2007
Medicine
mothers-to-be would be suffering from asthma as well.
Bulky uterus since 21/04/2007
Allergy Asthma often worsen during pregnancy, especially in conditions that are already severe. There
are others who improve during pregnancy, especially if their disease was mild before they
Dietary
became pregnant. Another third experience no change. Cases where asthma or asthma attacks
Exercise become worse, they mostly occur during 24 to 36 weeks of pregnancy. Only about 1 in 10
women with asthma have symptoms during delivery.
Medication - to take or not to take
Continuing to take asthma medications during pregnancy is a must. One can do worse damage
by not taking them.
The hospital reminds Today there are many excellent medications for treating asthma and allergies. Although no
Chest X Ray received at 22/10/2007 10:05 AM
medication can be proven entirely safe for use during pregnancy, the patient and the doctor can
the patient of the work together to develop a treatment plan that carefully balances medication use and symptom
control, and assures that the potential benefits of the medication outweigh the potential risks o
next appointments – the medication and of uncontrolled asthma.
Can one take allergy shots during pregnancy?
and gives education Allergy shots do not have an adverse effect on pregnancy, so they can be continued. As always
Pharma Order: Autrin atyour
21/10/2007 6:10
allergist PM
will monitor your dose to lessen the risk of an allergic reaction to the shots. These

material for each reactions

Radiology order: ECG order are rare;
at 21/10/2007 however,
6:10 PM such a reaction could 200
Tranexa be harmful to the fetus.
mg not administered
treatments should not be started for the first time during pregnancy
Allergy
since shot 9:00 PM
21/10/2007

trimester- using pre-

defined templates
 31 yrs 11 m on 8 d Fem ale Em ergency
Anita Roy
4 - Full term pregnancy

Severe pain

60 99.1 125

40 80 100

Patient appears at Full term pregnancy Under hospital

supervision
emergency without
any records – triage
conducted at the ER
 Anita 31 yrs 11 mon 8 d Female Room #6 Bed #3
Roy Full term pregnancy
1

I rregular menses with pain in lower abdomen since 21/04/2007

Excessive menstrual bleeding since 18/10/2007
Bulky uterus since 21/04/2007

Attending doctor Chest X Ray received at 22/10/2007 10:05 AM

views patient history

allergies, radiology
reports, Pharma Order: Autrin at 21/10/2007 6:10 PM

medications, past Radiology order: ECG order at 21/10/2007 6:10 PM Appears at emergency with full term on 22/10/2007 11:30 PM

lab results and other

specific instructions
The admitting doctor
consults with the
attending
gynecologist on
phone
 Anita 41 yrs 11 mon 8 d Female Room #6 Bed
Roy I rregular menses with pain in lower ..
1

Doctor manages
pain and schedules
patient for surgery
 Anita 41 yrs 11 mon 8 d Female Room #6 Be
Roy I rregular menses with pain in lower .
1

Primary surgeon : Dr. D. Sinha

Proc surgeon : Dr. R. Gupta
Monitoring staff : Shyamala
Pre-op checklists given 120
Monitoring start :10/11/2007 11:00 am

to nurse using
100

templates – patient is
80

monitored through ITEMS 60

Systolic BP
Diastolic BP 40
flowsheet and charts
 Anita 31 yrs 11 mon 8 d Female Room #6 Be
Roy Full term pregnancy by LSCS for CP
4

Spinal anesthesia started with full aseptic

and antiseptic precautions

OT notes during the Abdomen open by transverse incision

surgery prepared Lower segment Caesarean Section (LSCS)

using templates done

Alive male child taken out

 Anita 41 yrs 11 mon 8 d Female Room #6 Bed
Roy I rregular menses with pain in lower .
1

After the surgery,

the patient is
monitored and
medication record
prepared
 ANITA ROY

17 NOV 1979 FEMALE HOUSEWIFE

Emergency arrival with labor pain

Routine investigations to establish surgical fitness – USG, CBC, routine urine, blood sugar, serum, SGPT

Discharge summary Full term pregnancy requiring Cesarean section

is automatically
prepared and Cesarean section was conducted. Infant and m other recuperated sufficiently. The postoperative period was uneventful.
Som e bleeding seen, mostly in the anterior uterine wall.
specific follow up
instructions are
given using
Baby automatically
registered in the
hospital for
subsequent visits
 0 yr 0 mon 2 d -

1 Nil Nil

Nil

-
Born of LSCS. Uneventful birth.

Maternal grandmother with a history of asthma

Pediatrician
18
assigned, history 6.2

and vitals Nil

maintained as Nil

medical record
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