CASE DISCUSSION

ANEMIA COPLICATING
PREGNANCY
Mrs.Revathy,26 yrs, coming from Medavakkam, a
homemaker, studied upto 10th standard, belonging to
Socio-economic class – IV ,

G2P1L1 / previous LSCS

LMP 28-03-12. EDD : 05-01-13

GA – 37 wks 3 days

With H/O 9 months amenorrhoea admitted with

complaints of easy fatiguability for past 1 month.
H/O Presenting illness
History of easy fatiguability – one month, gradual in
onset .
H/O loss of appetite+
 No H/o swelling of legs.
 No H/o breathlessness
No H/o palpitation/ chest pain/ orthopnoea/ PND
No H/O chronic cough / hemoptysis
No H/o difficulty in swallowing
No H/O decreased urine output, recurrent UTI, fever
No H/O recurrent diarrhoea / blood in stools / passing
worms in stool
No h/o perianal itch
No H/O chronic renal disease
No h/o skin / nail changes
No H/O bleeding PV in present pregnancy
No H/O loss of weight
No h/o pain abdomen / draining PV.
Able to perceive fetal movements well
Menstrual H/O: Menarche – 14 yrs
3/30 regular cycles moderate flow.
Changes 2-3 pads/ day, no h/o dysmenorrhoea
Marital H/O: Married for 4yrs, NCM
Not living with her husband for past 2 months
Obstetric H/O :
Ist pregnancy:
conceived spontaneously after 3 months of marriage ,
booked and immunised. Had regular Antenatal check up.
h/o iron and folic acid intake regularly from 5 months of
amenorrhea
 No history suggestive of anaemia during pregnancy.
 No history suggestive of PET
 Delivered by emergency LSCS for failed induction 4 yrs
ago at Madurai GH, Alive male baby B.Wt-3.5kg . Baby
alive and healthy.
 No H/O excessive blood loss following delivery
 No H/O blood transfusion
 Resumed periods after 1 year and 4 months
 Lactated for 2 years. No h/o any contraceptive use
IInd pregnancy :
Spontaneous conception after 4yrs of previous
pregnancy.
Confirmed after 2 months of amenorrhea by UPT
1 trimester -
No H/O dating scan
No H/O folic acid intake
No H/O excessive vomiting.
No H/O fever/ urinary infection/ radiation exposure
No H/o drug intake
No H/O bleeding or spotting PV
 II trimester- Quickening felt at 5 MA
 Had 1 dose of inj TT at 6 months of amenorrhea,
 scan done at 6 months and said to be normal
 Had AN check up only once
 No h/o iron and folic acid intake.
 No h/o swelling of legs,
 NO h/o breathlessness/ palpitation/ chest pain
 No h/o burning micturition
 No h/o bleeding pv / draining pv
III Trimester : Able to perceive fetal movements.
No h/o swellling of legs
No h/o burning micturition / bowel disturbances
No h/o pain abdomen/ bleeding pv / draining pv

Past H/O
No H/O HT / DM /TB / BA/ Thyroid disease /
epilepsy/ Jaundice
No H/O major surgeries
No H/O blood transfusions
 Personal H/O
 Mixed diet.
 Bladder and bowel habits are normal.
 Family H/O
 she is an orphan brought up in orphanage
home.
 DRUG H/O
 No h/o any drug intake
 No h/o intolerance to iron tablets / allergy
to systemic iron
GENERAL EXAMINATION
 Patient comfortable at rest.
 Not dysnoeic / Tachyneic.
 moderately built & nourished
 Pallor +
 afebrile
 No icterus
 No pedal edema.
 No significant lymphadenopathy
 No frontal bossing / sternal tenderness
 No leg ulcers
No koilonychia / spotted nails Ht: 160 cm
No cyanosis Wt : 75kg
JVP not elevated BMI : 22.65
Thyroid, breast, spine -normal.
Temp : N
P.R 92/min, Reg
B.P 100/70 mmHg
R.R : 16 /min
CVS : S1 S2 +, No murmur. No thrill
RS : NVBS +, No added sounds
CNS : NFND
ABDOMEN
On Inspection
 Longitudinally enlarged corresponding to 36
weeks.
 Umbilicus midline flushed to surfce.
 Linea nigra +
 Striae gravidarum+
 SPT scar +, healthy
 No dilated veins, pulsations
 Hernial orifices free
On palpation:
Uterus enlarged to 36 wks. Flanks free
Symphysiofundal height – 34 cm
Fundal Grip : Broad firm independently non ballotable
breech Felt.
Umbilical Grip : Right side - hard resistance surface
slightly curved - back felt.
Left side - limb buds felt.
 First pelvic Grip : hard round
independantly ballotable mass – head felt
unengaged ,
 Second pelvic Grip : Confirms first pelvic
grip.
 Clinically liquor adequate
 EFW -3 kg
 Abdominal girth – 91 cm
 Auscultation : FHR : 138 bpm, regular
rhythm, normal tone heard in the right
spinoumbilical line
 SUMMARY
 Mrs. Revathi 26 years gravida 2 para 1 live 1 coming
from low socioeconomic status admitted for the
complaint of easy fatigability for the past one month. Her
LMP was 28/03/2012 EDD was
05/01/2013 with 37 wks 3 days of GA
 She is an unbooked case not on iron and folic acid tablets
 On physical examination, pallor ++, no jaundice, pulse
92/min , liver and spleen not palpable.
 On obstetrical examination, uterus is longitudinal, 36
weeks size cephalic presentation, head unengaged,
FHS(+) Rate -138/min, reg situated on rt spinoumbilical
line
DIAGNOSIS
26 yr old unbooked G2P1L1 / prev LSCS 37 wks 3
days GA with single live fetus in cephalic
presentation, good fetal heart rate with anaemia
complicating pregnancy not in failure for further
management.