June 10-11

Endorsement
 June 10-11, 2018
Total # of Admissions:
OB GYNE

Private

Charity
 Admissions
1. Zaragoza, Jessica

2. Guanzon, Elvira

3. Romo, Lazarela

4. Sia, Annie

5. Alojado, Corazon

6. Mongcal, Rodelyn

7. Amit
 Guanzon, Elvira
• 29/Single
• G0

• Chief Complaint: right lower quadrant pain

• History of Present Illness
• 3 weeks Prior to Admission, patient had sudden onset of dull, crampy
hypogastric pain, pain scale 5/10, intermittent, non-radiating, with associated
undocumented fever. Consult done with a private physician and was managed
as Urinary Tract Infection

• Prescribed Co-Amoxiclav 625 mg/tab 1 tab TID x 10 days and Paracetamol

500 mg/tab 1 tab every 4 hours with good compliance and no relief of
symptoms
 • 11 days Prior to Admission: persistence of abdominal pain prompted
consult with another private physician —> prescribed Cefuroxime 500
mg/tab 1 tab BID x 3 days and an ultrasound was done with an OB
Sonologist

Normal sized, anteverted uterus (4.6 x 3.5 x 4.6 cm) with thin endometrium (0.5 cm)
Cervix (3.6 x 2.4 x 3.0 cm)
Right ovary (3.3. x 3.2 x 3.3 cm) lateral to the uterus, with unilocular cyst containing level
echoes (2.7 x 25 x 2.5 cm)
Left ovary (10.8 x 8.1 x 8.5 cm), posterior to the uterus, cystic, containing low-medium level
echoes
No fluid in the cul de sac

• Referred to this institution for further management

Transvaginal Ultrasound (June 2, 2018)
• Uterus is anteverted, deviated to the left with smooth contour and homogenous
echopattern measuring 7.2 x 3.3 x 3.7 cm (cervix 2.7 x 2.9 x 2.4 cm). Endometrium is
0.5 cm thick

• Left ovary measures 11.0 x 9.2 x 7.8 cm with 2 cysts, 1 containing low to medium level
echoes measuring 7.8 x 8.0 x 8.1 cm while the other contains medium level echoes
measuring 3.0 x 3.0 x 2.6 cm, adherent to the posterior portion of the uterus

• Right ovary measures 3.6 x 2.8 x 2.7 cm with a unilocular cystic structure containing
medium level echoes measuring 2.5 x 2.3 x 2.0 cm, lateral to the uterus. Both ovaries
are adherent to each other. Minimal fluid in the cul de sac

• Consider pelvic endometriosis with bilateral endometrial cysts

• Normal sized anteverted uterus with proliferative phase endometrium

• 14 hours Prior to Admission: noted onset of right lower
quadrant pain, steady, cramping, pain scale 8/10,
nonradiating, aggravated by defecation, with associated
difficulty in ambulating. No medications taken. Persistence
of pain prompted admission.
• PAST MEDICAL HISTORY • PERSONAL AND SOCIAL
HISTORY
• (-) Hypertension
• Nonsmoker
• (-) Diabetes mellitus
• Non-alcoholic beverage drinker
• (-) Bronchial asthma
• Works as a teacher
• (-) Food and Drug Allergies
• FAMILY HISTORY

• Maternal hypertension and diabetes

mellitus
• OBGYNE HISTORY • Coitarche: 22 years old

• G0 • # of sexual partners: 1

• Menarche: 11 years old • Family planning methods: none

• Interval: regular • Papsmear: none

• Duration: 2-3 days • LMP: May 26, 2018 x 1 day

• Amount: 3 pads/day fully soaked • PMP: May 1, 2018 x 2-3 days

• Symptoms: (+) dysmenorrhea

 Physical Examination
• BP 120/80 HR 112 bpm RR 23 cpm Temp 35.3 *C
• Awake, alert, not in apparent cardiopulmonar distress
• Anicteric sclerae, pinkish palpebral conjunctiva
• Symmetrical chest expansion with clear breath sounds
• Adynamic precordium with regular rate and rhythm
• Soft abdomen, (+) direct RLQ tenderness, (+) mass at umbilical area,
nontender
• Full peripheral pulses, CRT <2 seconds
 Internal Examination

• Grossly normal introitus, smooth vaginal walls

• Cervix 2x2 cm in size, (+) nodularities noted

• Uterus enlarged to 20 weeks size

• (+) fixed adnexal mass on the right approx. 3x5 cm in size

• Clear mucoid discharges
 Assessment
• G0 to consider Ruptured Ovarian New Growth,
Bilateral

• Final Diagnosis: G0 Rupture Ovarian New

Growth, Left, to consider Infected Endometrial
Cyst, Status: Post Pelvic Laparotomy,
Adhesiolysis, Left Salpingooophorectomy,
Appendectomy
 Alojado, Corazon
• 55/Widow
• G6P6 (6006)
• Chief Complaint: vaginal bleeding
• History of Present Illness:
• 1 year prior to admission: patient had vaginal bleeding for 3 days, consuming 3 fully soaked
pads, with associated passage of blood clots, with associated hypogastric discomfort. No
consult done and no medications taken.
• 2 months prior to admission: recurrence of vaginal bleeding lasting for 3 days consuming 3
fully soaked pads with still no consult done
• 1 month prior to admission: noted 3 days of vaginal bleeding. No consult done
• 3 days prior to admission: consult done with AP. TVS was done showing thickened
postmenopausal endometrium (0.77 cm) and was advised diagnostic dilatation and
curettage hence admission
 Ultrasound (June 6, 2018)
• Uterus is anteveted with smooth contour and homogenous echopattern
measuring 7.7 x 4.4 x 4.2 cm (cervical portion measures 2.9 x 3.3 cm)

• Endometrium is hyperechoic measuring 0.77 cm thick

• Right ovary measures 2.1 x 1.4 x 1.1 cm with an anechoic cystic structure
measuring 0.82 x 0.87 x 0.79 cm

• Left ovary not visualized

• Remarks: thickened postmenopausal endometrium, cystic right ovary,
nonvisualized left ovary
• PAST MEDICAL HISTORY • FAMILY HISTORY

• (+) Hypertension • Paternal hypertension and diabetes

mellitus
• Metropolol 500 mg/tab 1 tab BID
• PERSONAL AND SOCIAL
• Amlodipine 5 mg/tab 1 tab OD HISTORY

• Trimetazidine 35 mg/tab 1 tab BID • Nonsmoker

• Aspirin 80 mg/tab OD • Non-alcoholic beverage drinker

• (-) Diabetes mellitus

• (-) Bronchial asthma

• (-) Food and Drug Allergies

• OBGYNE HISTORY • G1 1987 - NSVD
• Menarche: 12 years old • G2 1989 - NSVD
• Interval: regular • G3 1991 - NSVD
• Duration: 3 days • G4 1993 - NSVD
• Amount:
soaked
4-5 pads/day moderately • G5 1995 - NSVD
• Symptoms: (-) dysmenorrhea
• G6 2003 - NSVD
• Menopause at 53 years old
• Coitarche: 23 years old
• # of sexual partners: 2
• Family planning methods: none
• Papsmear:
results
May 5, 2018 pending

• G6P6 (6006)
 Physical Examination
• BP 120/80 HR 69 bpm RR 19 cpm Temp 36.6 *C
• Awake, alert, not in apparent cardiopulmonar distress
• Anicteric sclerae, pinkish palpebral conjunctiva
• Symmetrical chest expansion with clear breath sounds
• Adynamic precordium with regular rate and rhythm
• Soft abdomen, nontender
• Full peripheral pulses, CRT <2 seconds
Laboratories
 Assessment

• G6P6 (6006) Abnormal Uterine Bleeding secondary

to Endometrial Pathology

• Plan: for diagnostic dilatation and curettage

 Mongcal, Rodelyn
• 30/Married

• G1P0

• Chief complaint: irregular uterine contractions

• History of Present Illness:

• 2 days prior to admission, onset of irregular uterine contractions, 1 contraction
every 1-2 hours, mild to moderate in intensity, lasting for 30 seconds, with no
associated vaginal bleeding or discharges

• Patient was scheduled for elective cesarean section hence admission

Latest Ultrasound (37 5/7 weeks AOG by EUTZ)

• Single live intrauterine pregnancy, female fetal sex, breech presentation,

more than 40 weeks age of gestation by biparietal diameter and femoral
length with good cardiac and somatic acvities

• Placenta right posterolateral, grade 2-3, no previa

• Estimated fetal weight appropriate for 40 weeks AOG (Hadlock 6 lbs 12 oz,
Warsof 6 lbs 11 oz)

• Adequate amniotic fluid (amntiotic fluid index = 11.3 cm)

• Biophysical Profile Score 8/8

• PAST MEDICAL HISTORY • FAMILY HISTORY

• (+) Bronchial Asthma • Paternal hypertension

• Fluticasone + Salmeterol 2 puffs • Maternal diabetes mellitus

BID
• PERSONAL AND SOCIAL
• Last exacerbation: 27 1/7 weeks HISTORY
AOG
• Nonsmoker
• (-) Hypertension
• Non-alcoholic beverage drinker
• (-) Diabetes mellitus

• (-) Food and Drug Allergies

• OBGYNE HISTORY • G1P0
• Menarche: 14 years old • LMP: August 17, 2017
• Interval: irregular • AOG: 38 6/7 weeks by EUTZ
• Duration: 5 days • EDC: June 18, 2018
• Amount:
soaked
6-8 pads/day moderately

• Symptoms: (-) dysmenorrhea

• Coitarche: 20 years old
• # of sexual partners: 1
• Family planning methods: condom
• Papsmear: none
 Obstetric Course
• 1st Prenatal Check-up: Saudi Arabia at 4 6/7 weeks AOG
• Total Visits: 2

• Medications: Folic Acid OD

• 1st trimester illnesses: vaginal spotting (~8 weeks AOG) —>

Didrogesterone 10 mg/tab 1 tab BID X 27 days
• Next Prenatal Check-up: OB OPD at 27 1/7 weeks AOG
• 2nd trimester illnesses:
• (27 1/7 weeks AOG) Bronchial Asthma in Acute Exacerbation —> Fluticasone +
Salmeterol 2 puffs BID
• 3rd trimester illnesses:
• (36
days
1/7 weeks AOG) Cervicovaginitis —> Cefuroxime 500 mg/tab 1 tab BID x 7
 Physical Examination
• BP 110/70 HR 63 bpm RR 18 cpm Temp 36.5 *C
• Awake, alert, not in apparent cardiopulmonar distress
• Anicteric sclerae, pinkish palpebral conjunctiva
• Symmetrical chest expansion with clear breath sounds
• Adynamic precordium with regular rate and rhythm
• Abdomen gravid, nontender, with no contractions
• Full peripheral pulses, CRT <2 seconds
• Fundic Height : 33 cm

• Fetal Heart Beat : 144 bpm X

• Leopolds I: cephalic

• Leopolds II: Fetal back at maternal right

• Leopolds III: not engaged

• Leopolds IV: breech

• IE: closed cervix

 Assessment

• G1P0 Pregnancy Uterine 38 6/7 weeks Age of

Gestation by Early Ultrasound, Breech Not in
Labor, Bronchial Asthma not in Acute Exacerbation

• Plan: for elective low transverse cesarean section I

(6/11/18)