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Admitting conference

October 9 - 10
DRs MACASPAC/ RONQUILLO-SARMIENTO
PGIs SHRESTHA/ VITUG

OB-CASES

GYNE-CASES

(i) Service

1 (pathologic)

(ii) Private

2 (non-pathologic)

(i) Service

(ii) Private

1 (pathologic)

RESOLVED:

UNRESOLVED:

Total: 6

Ward Census
FLOOR

OLD

NEW

REFERRAL

TOTAL

3RD MB

3RD MT

5TH MB

5TH MT

8Th MT

ICU

TOTAL

10

Patient Profile # 1
MB, 33

G2P1
(1001)

Filipino

Guagua

CC: increase in blood pressure

Few hours PTA

(+) BP of 184/130
(+) Headache
(-) Nausea/ Vomiting
(-) vaginal bleeding
(-) hypogastric pain
Consult

History of Present Illness

PAST
MEDICAL
(+) HPN x 15 yr
Aldomet
(-) DM
(+) Asthma
Last attack- 2yr ago
Asthmalin
(-) Allergy
(-) Goiter
(-) hepatitis

FAMILY HX

(+) DM- maternal


(+) HTN- paternal
(-) ASTHMA
(-) CA
(-) heart disease

P AND S HX
(-) Smoker
(-) Alcoholic bev.
Drinker
Catholic
college graduate
unemployed
Married

Obstetrics History
G2P1 (1001)
G1 : 2006, FTBB, CSI x Preeclampsia,

Private Hospital, 2.2 kg, alive


G2 : Present Pregnancy
LMP: unsure
EDC: 12/20/2014 by UTZ
AOG: 29 5/7 wks

Gynecologic History
M=13 Y/O
I= Irregular, 3-6 mo
D= 5 DAYS
A= 5 PPD/FULLY SOAKED
S=(-) DYSMENORRHEA
1st SC:
#SP:
(+) OCP use 1 YEAR (2009)
(-) Post-Coital Bleeding
(-) Dyspareunia
(-) Pap Smear

PHYSICAL EXAMINATION
General: awake, conscious, coherent, not in

cardio-respiratory distress

Vital signs:
BP: 170/120 PR: 87 RR: 19 Temp: 36oC
Height: 55
Previous Weight: 51 kg, BMI= 18.7 kg/m2
Current Weight: 60 kg, BMI= 22 kg/m2
Wt. gain: 9 kg

PHYSICAL EXAMINATION
HEENT: pink palpebral conjunctivae,

anicteric sclerae

Lungs: symmetrical chest expansion, (-)

retractions, clear breath sounds

Heart: adynamic precordium, (-) murmur,

normal rate and rhythm

PHYSICAL EXAMINATION
Abdomen:

globular, non tender, + striae

FH: 30cm FHT 140s

Leopolds maneuver:
LM1: large, nodular mass occupies the fundus (breech)
LM2: hard resistant structure on the right maternal side, irregular mobile parts on the
left maternal side
LM3: hard, round non-ballotable structure (cephalic, engaged)
LM4: head descent, cephalic prominence on the opposite side of the fetal back
IE: Cervix closed
Extremities: full and equal pulses, (-) edema

Initial CTG

B FHT: 150-155s, moderate variability, (+) accelerations, (-) decelerations, UC: none

Admitting diagnosis
G2P1 (1001) PU 29 6/7 weeks AOG,

Not in labor
Chronic hypertension with
superimposed severe preeclampsia

PLAN
MgSO4 5g deep IM on each buttocks
Hydralazine 5mg/IV
Dexamethasone 6mg/IM
MgSO4 drip MgSO4 10g in PNSS 500cc x 100cc/hr

Patient Profile # 2
MG, 31

G2P1
(1001)

Filipino

Mabalacat

CC: Hypogastric pain

Few hours PTA

(+) Hypogastric pain


(+) Bloody mucoid discharge
(-) Watery vaginal discharge
(+) Good fetal movement
Consult

History of Present Illness

PAST
MEDICAL

(-) HPN
(-) DM
(-) Asthma
(-) Allergy
(-) Goiter
(-) hepatitis

FAMILY HX

(+) DM- paternal


(+) HTN- paternal
(-) PTB
(-) ASTHMA
(-) CA
(-) heart disease

P AND S HX
(-) Smoker
(-) Alcoholic bev.
Drinker
Married
Catholic
College graduate
Ophtha Nurse

Obstetrics History
G2P1 (1001)
G1 2012, FTBG, NSD, lying-in clinic,

6lbs., (-) complications, alive


G2 Present pregnancy
LMP Jan. 2014
EDC 10/17/14 by UTZ
AOG 38 6/7

1st PNCU 6 weeks AOG


#PNCU - >10

Gynecologic History
M=13 Y/O
I= Regular, 30 day cycle
D= 4 DAYS
A= 4-5 PPD/MODERATELY SOAKED
S=(-) DYSMENORRHEA
1st SC: 20
#SP: 1
(-) OCP use
(-) Post-Coital Bleeding
(-) Dyspareunia
(-) Pap Smear

PHYSICAL EXAMINATION
General: awake, conscious, coherent, not in

cardio-respiratory distress

Vital signs:
BP: 130/80 PR: 84 RR: 18 Temp: 36.6oC
Height: 55
Previous Weight: 134 lbs, BMI= 22.4 kg/m2
Previous Weight: 160 lbs, BMI= 26.7 kg/m2
Wt. gain: 26 lbs

PHYSICAL EXAMINATION
HEENT: pink palpebral conjunctivae,

anicteric sclerae

Lungs: symmetrical chest expansion, (-)

retractions, clear breath sounds

Heart: adynamic precordium, (-) murmur,

normal rate and rhythm

PHYSICAL EXAMINATION
Abdomen:

globular, non tender

FH: 34cm FHT 140s EFW: 3410 gm

Leopolds maneuver:
LM1: large, nodular mass occupies the fundus (breech)
LM2: hard resistant structure on the right maternal side, irregular mobile parts on the left
maternal side
LM3: hard, round non-ballotable structure (cephalic, engaged)
LM4: head descent, cephalic prominence on the opposite side of the fetal back
IE: Cervix 3 cm dilated (2), posterior position (0), 60 % effaced (2), med. soft (1), cephalic,
(+) BOW, Station -3 (0)
Bishop score: 5

Initial CTG

B FHT: 150-155, Moderate variability, (+) accelerations, (-) decelerations, UC: moderate
contractions every 2-3 minutes in a 20 min. strip, Montevideo units: 360

Labor Curve

HNBB 1 amp

D5LRS IL
30gtts/min
-5

HNBB 1 amp
Epidural
anesthesia

Nubain 5mg +
Promethazine
25mg/IV

Nubain 5mg +
Promethazine
25mg/IV

10

-4

-3
-2

8
7

-1

+1

+2

+3

+4

+5

0
0

10

9pm

10

11

12

1am

11

Admitting diagnosis
G2P1 (1001) Pregnancy Uterine 38

6/7 weeks AOG, Cephalic, in labor

PLAN
Awaits delivery

Patient Profile # 3 (Service)


SM, 26

G2P0
(0010)

Filipino

Angeles
city

CC: watery vaginal discharge

Few hours PTA

(+) Watery vaginal discharge


(+) hypogastric pain
(-) vaginal bleeding
(+) good fetal movement
Consult

History of Present Illness

PAST
MEDICAL
(-) HPN
(-) DM
(+) Asthma
Last attack : HS
(+) Allergy: Cefalexin
(-) Goiter
(-) hepatitis

FAMILY HX
(+) DM- paternal
(-) HTN
(-) ASTHMA
(+) CA- breast Camaternal
(-) heart disease

P AND S HX
(-) Smoker
(-) Alcoholic bev.
Drinker
Catholic
Vocational graduate
Cashier
Married 6 mo

Obstetrics History
G2P0
G1 : 2008, 1 mo, complete miscarriage
G2: PP

LMP: 01/03/2014
EDC: 10/10/2014

Gynecologic History
M=13 Y/O
I= Regular, 28 day cycle
D= 3-4 DAYS
A= 4-5 PPD/MODERATELY SOAKED
S=(+) DYSMENORRHEA
1st SC: 17
#SP: 4
(-) OCP use
(-) Post-Coital Bleeding
(-) Dyspareunia
(-) Pap Smear

PHYSICAL EXAMINATION
General: awake, conscious, coherent, not in

cardio-respiratory distress

Vital signs:
BP: 120/80 PR: 88 RR: 19 Temp: 36.6oC
Height: 54
Previous Weight: 52 kg, BMI= 19.7 kg/m2
Current Weight: 65 kg, BMI= 24.6 kg/m2
Wt. gain: 13 kg

PHYSICAL EXAMINATION
HEENT: pink palpebral conjunctivae,

anicteric sclerae

Lungs: symmetrical chest expansion, (-)

retractions, clear breath sounds

Heart: adynamic precordium, (-) murmur,

normal rate and rhythm

PHYSICAL EXAMINATION
Abdomen:

globular, non tender, + striae

FH: 34cm FHT 140s EFW: 3410 gm

Leopolds maneuver:
LM1: large, nodular mass occupies the fundus (breech)
LM2: hard resistant structure on the right maternal side, irregular mobile parts on the
left maternal side
LM3: hard, round non-ballotable structure (cephalic, engaged)
LM4: head descent, cephalic prominence on the opposite side of the fetal back
IE: Cervix 3 cm dilated (2), posterior position (0), 50 % effaced (1), soft (2), cephalic,
(-) BOW, Station -2 (1)
Bishop score: 6

Initial CTG

B FHT: 145-150s, minimal-moderate variability, (+) accelerations, (-) decelerations, UC:


moderate contractions every 2-3 minutes in a 20 min. strip, Montevideo units: 250

D5LRS IL + 10 u
Oxytocin 10
gtts/min

-5

10

-4

-3
-2

8
7

-1

+1

+2

+3

+4

+5
9

0
pm

10

11

12

1 amp HNBB

1 amp HNBB

Admitting diagnosis
G2P0 (0010) PU 39 6/7 weeks AOG,

Cephalic, in labor, GDM - diet


controlled

PLAN
Awaits delivery

Final Diagnosis
G2P0 (0010) PU term cephalic delivered via NSVD

live birth baby boy, BW 2.94kg, BL : 51cm, AS 8,9


NMR 39 weeks AGA, thickly meconium stained
amniotic fluid, GDM - diet controlled

Patient Profile # 4
IT, 27

G1P0

Filipino

Angeles
city

CC: Watery vaginal discharge

Few hours PTA

(+) watery vaginal discharge


(-) vaginal bleeding
(-) hypogastric pain
(+) good fetal movement
Consult

History of Present Illness

PAST
MEDICAL

(-) HPN
(-) DM
(-) Asthma
(-) Allergy
(-) Goiter
(-) hepatitis

FAMILY HX

(+) DM- paternal


(+) HTN- paternal
(-) ASTHMA
(-) CA
(-) heart disease

P AND S HX
(-) Smoker
(-) Alcoholic bev.
Drinker
Born again
Vocational graduate
Technician
Married

Obstetrics History
G1P0
G1 : Present Pregnancy
LMP 1/7/14
EDC 10/14/14
AOG 39 2/7

Gynecologic History
M=12 Y/O
I= Regular, 28 day cycle
D= 4-5 DAYS
A= 4-5 PPD/MODERATELY SOAKED
S=(-) DYSMENORRHEA
1st SC: 26
#SP: 1
(-) OCP use
(-) Post-Coital Bleeding
(-) Dyspareunia
(-) Pap Smear

PHYSICAL EXAMINATION
General: awake, conscious, coherent, not in

cardio-respiratory distress

Vital signs:
BP: 120/80 PR: 88 RR: 19 Temp: 36.6oC
Height: 54
Previous Weight: 132 lbs, BMI= 22.7 kg/m2
Current Weight: 157 lbs, BMI= 26.9 kg/m2
Wt. gain: 25 lbs

PHYSICAL EXAMINATION
HEENT: pink palpebral conjunctivae,

anicteric sclerae

Lungs: symmetrical chest expansion, (-)

retractions, clear breath sounds

Heart: adynamic precordium, (-) murmur,

normal rate and rhythm

PHYSICAL EXAMINATION
Abdomen:

globular, non tender, + striae

FH: 34cm FHT 140s EFW: 3410 gm

Leopolds maneuver:
LM1: large, nodular mass occupies the fundus (breech)
LM2: hard resistant structure on the right maternal side, irregular mobile parts on the
left maternal side
LM3: hard, round non-ballotable structure (cephalic, engaged)
LM4: head descent, cephalic prominence on the opposite side of the fetal back
IE: Cervix 3 cm dilated (2), posterior position (0), 50 % effaced (1), soft (2), cephalic,
(+) BOW, Station -2 (1)
Bishop score: 6

Initial CTG

B FHT: 130-135s, Moderate variability, (+) accelerations, (-) decelerations, UC: moderate
contractions every 4-5 minutes in a 20 min. strip, Montevideo units: 200

Nubain 5mg +
Promethazine
25mg/IV

D5LRS IL + 10 u
Oxytocin 10
gtts/min

-5

10

-4

-3
-2

8
7

-1

+1

+2

+3

+4

+5
12pm 1

0
2

1 amp HNBB

6
1 amp HNBB

Admitting diagnosis
G1P0 PU 39 2/7 weeks AOG,

Cephalic, in labor

PLAN
Awaits delivery

Final Diagnosis
G1P1 (1001) PU Term cephalic delivered via

NSVD, LBBB BW 2.89 kg, BL 48cm AS 8,9 NMR


39 weeks AGA, Single nuchal cord coil

Patient Profile # 3
KA, 22

G1P0
(0010)
Filipino

Catholic

Mabalacat

CC: Vaginal bleeding

5 weeks
PTA

2 weeks
PTA

(+) Vaginal bleeding with clots


(+) consult was done
TVS: thickened endometrium
D&C was done

(+) Vaginal bleeding, 3-4 ppd


No consult

History of Present Illness

Few hours PTA

Persistence of vaginal
bleeding
Consult at another PMD
Advised admission

History of Present Illness

PAST
MEDICAL

(-) HPN
(-) DM
(-) Asthma
(-) Allergy
(-) Goiter

FAMILY HX

(-) DM
(-) HTN
(-) PTB
(-) ASTHMA
(-) Breast

P AND S HX
(-) Smoker
(-) Alcoholic
bev. drinker
Single
INC
Highschool
undergraduate
Unemployed

Obstetrics History
G1P0 (0010)
G1 2014, 4 months AOG, evacuated by D&C, Private

hospital

Gynecologic History
M=13 Y/O
I= Regular, 30 days cycle
D= 3-4 DAYS
A= 8 PPD/MODERATELY SOAKED
S= (-) DYSMENORRHEA
1st Sexual Contact: 17
Number of Sexual partners: 3
(-) OCP
(-) Post-Coital Bleeding
(-) Dyspareunia
(-) Pap Smear

PHYSICAL EXAMINATION
General: awake, conscious, coherent, not in

cardio-respiratory distress

Vital signs:
BP: 110/70 PR: 72 RR: 18 Temp: 36.3
Height: 5
Current weight: 39kg
BMI 17 kg/m2 (Underweight)

PHYSICAL EXAMINATION
HEENT: pink palpebral conjunctivae, anicteric

sclerae

Lungs: symmetrical chest expansion, (-)

retractions, clear breath sounds

Heart: adynamic precordium, (-) murmur,

normal rate and rhythm

Abdomen:

Flabby, NABS, non tender

Extremities: full and equal pulses, (-) edema

PHYSICAL EXAMINATION
Abdomen:

Flat, NABS, soft, non tender

SE: cervix pink, smooth, (-) erosions, (-) active bleeding


IE: cervix closed
Extremities: full and equal pulses, (-) edema

Admitting diagnosis
G1P0 (0010) Abnormal Uterine Bleeding
s/p D&C September 4, 2014

Plan
IVF: D5LRS 1L x KVO
For CBC, Blood typing
Tranexamic acid 1g/IV

Patient Profile # 4
PA, 31
Catholic

G3P2
(2012)
Angeles
City

Filipino

CC: Prolonged menses

2 weeks
PTA

1 day
PTA

(+) Vaginal bleeding, 3-4 ppd


(-) Hypogastric pain
No consult

Persistence of vaginal bleeding


Consult done, TVS: thickened
endometrium
Scheduled for D&C

History of Present Illness

PAST
MEDICAL

(-) HPN
(-) DM
(-) Asthma
(-) Allergy
(-) Goiter

FAMILY HX

(-) DM
(-) HTN
(-) PTB
(-) ASTHMA
(-) Breast

P AND S HX
(-) Smoker
(+) Occ.
alcoholic bev.
drinker
Single
Catholic
College
graduate
Call center
agent

Obstetrics History
G3P2 (2012)
G1 2004, 3 months AOG, evacuated by D&C, Private

hospital
G2 2004, FTBB, CS I x fetal distress, Private hospital,
6.6 lbs, (-) complications, alive
G3 2008, FTBG, CS II x repeat, Private hospital, 4.6 lbs,
(-) complications, alive

Gynecologic History
M=13 Y/O
I= Irregular, 28 days - 3 months
D= 3-4 DAYS
A= 3 PPD/FULLY SOAKED
S= (-) DYSMENORRHEA
1st Sexual Contact: 18
Number of Sexual partners: 1
(-) OCP
(-) Post-Coital Bleeding
(-) Dyspareunia
(+) Pap Smear 2008, normal

PHYSICAL EXAMINATION
General: awake, conscious, coherent, not in

cardio-respiratory distress

Vital signs:
BP: 130/90 PR: 84 RR: 19 Temp: 36.3
Height: 55
Current weight: 162 lbs
BMI 36.9 kg/m2

PHYSICAL EXAMINATION
HEENT: pink palpebral conjunctivae, anicteric

sclerae

Lungs: symmetrical chest expansion, (-)

retractions, clear breath sounds

Heart: adynamic precordium, (-) murmur,

normal rate and rhythm

Abdomen:

Flabby, NABS, non tender

Extremities: full and equal pulses, (-) edema

Admitting diagnosis
G3P2 (2012) Abnormal Uterine Bleeding T/C

Endometrial Pathology

Plan
Dilatation and Curettage

Thank you

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