CASE PRESENTATION:

Patient Miss Rafia W/O Ijaz , 35 year

old resident of 89 NB Tehsil Sargodha visited
Mola Baksh hospital Emergency on 1st Jan 2019 at
12:35 p.m.She was 35 years old married for 1 year, PG at 39 plus
5 weeks by dates with presenting complaints of headache and
bluring of vision for 4 hours and lower abdominal pain for last
12 hours and watery vaginal discharge for last 3x days. The
Patient had history of trial from local LHV setup in the form of
injectables and IV drips since morning, patient had no history of
regular antenatal visits.
No previous record of any dating or anoemly scan was found and no
labs were done throughout her antenatal period, no history of folic
acid or any haemanitics intake found during pregnancy.No history of
raised BP with headache bluring of vision and GI upset.No history of
Poly phagia , poly dipsia or poly urea in 2nd and 3rd trimester.
2 Days ago patient had complaint regarding frontal headache for which
she visited her local practitioner, her BP was found to be 140/100 and
she was advised to take tablet aldomet 250 mg 1x tds
Upon presentation the patient was oriented in time place and person
with
pulse= 82 bpm ,
BP 160/110,
temperature = 98.6F
Respiratory rate = 18 pm
On abdominal examination
SFH=36 cm
L/C = 4/5 p/p
Liquor = could not accessed due to marked obesity
EFW= 2.5 to 2.8 kg
PUC = 2/10 of 20 seconds each
FHR = 110 to 114 with two decelerations
On vaginal Examination
OS = 2.5 cm
CX = soft central 1.5 cm in length
VX = -3
MX= absent
Draining Grade 1 Meconium
The patient was admitted in labor room, her
baseline investigations and PIH profile were sent
to lab. Injection Hydralazine and Injection
MGSO4 loading and maintenance were given ,
Patient was cathetrized , blood was arranged &
along with high risk consent regarding feto
maternal well being plan of emergency LSCS was
made due to fetal distress and imminent
eclampsia.
• IOF
Female baby of 2 kg delivered as cephalic with poor AS followed
by C/E of P/M.
Liquor was absent
Grade 3 meconium
600 ml acsitic fluid drained out and drain put in utero vesical
pouch
b/l ovaries and tubes healthy
Urine clear at the end
EBL=600ml
Intra operatively the patient had one episode of tonic colonic fits
1 pint blood transfused IOP
The patient shifted back to labor room after emergency LSCS for
strict vital monitoring and completion of MGSO4 maintenance
doses
,on her 1st POD the patient was haemodynamicaly stable, there
was no active A/C her chest was b/l clear,breast soft,NT,not
engorged.abd snt,uterus contracted,pvb=mild,DOP=10ml/hr.
Dressing d/I.patient was encourged to mobilize,urine r/e and
followup of baby to nusery was sent
• After 1st pod the patient shifted to ward.
• On her 6th pod the patient was discharged with
following findings;
• Hb=8.8g/dl,tlc=13300,plt=2,76000
• Albumin was nill in urine r/e
• Tab.adalat LA 1xod was added
• On her 8th pod the patient came in opd with p/c of
pussy discharge coming out from stitch line,the pt was
admitted in icu,iv antibiotics were advised along with
personal hygiene and high protein diet.
 Factors responsible for gaped wound
in this patient
1]Hypertention;
HTN damages the bv and heart as well.which
impact the blood flow and decreases the nutrients
and oxygene delivary to cellular level which
impedes wound healing.
2]anaemia;
Wound healing relies heavily on oxygenation,low
oxygen levels caused by anaemia have the ability to
halt or slow the wound healing stages
Which leaves the pts to more susceptible to
wound infections.
• 3]obesity;
Def in oxygene utilization and increased
inflammation assoc.with adipose tissue increase
the wound infection in obese pts
.4] post op potent iv antibiotics.
.5]poor personal hygiene.
• 6]high protein diet;
Wound healing process further exacerbates
protein loss as the body can lose 100mg of
protein per day due to exudation or fluid
leakage from affected area.
. 7] early mobilization