Morning sessionRed Unit17/10/2015

Dr. Namkha Dorji

Resident (Phase-B)Obstetrics and Gynaecology

BSMMU

05/01/23 1Dr Namkha Dorji, Resident, OBGYN, BSMMU

Total admission

Date No. of admission (Red Unit)10/10/15 411/10/15 5 12/10/15 413/10/15 214/10/15 425/10/15 3Total patients admitted = 22

05/01/23 2Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 1

• Name: Mrs. Afroza Sultana• Age: 31 year• Married for: 6 years• Para: (0) • Gravida: 1

Primigravida at 36+6 weeks pregnancy with fetal distress with oligohydramnios with IUGR and h/o primary subfertility.

. Diagnosis:

LUCS findings:•Female•2.1 kg•Reduced volume but clear liquor • Cord round the neck

USG:•AFI = 4.6 cm•EFW = 2040 grams

05/01/23 3Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 2

• Name: Mrs. Arzina Khatun • Age: 27 year• Married for: 5 years

• Para: (0 + 2) • Gravida: 3rd

3rd gravida at 30+6 week pregnancy with preterm labour with fetal distress

. Diagnosis:

1st = MR at 2 months2nd = Complete abortion at 2 months

05/01/23 4Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 3

• Name: Mrs. Shahnaj Begum• Age: 33 years• Para: (3+0)• Gravida: 4th

• Diagnosis: 4th gravida at 37+1 weeks of twin pregnancy (DADC) with

severe preeclampsia with p/h/o one LUCS with hypothyroidism and obesity (grade I)

BMI: 33 kg/m2

•1st & 2nd pregnancies: NVD•3rd pregnancy:LUCS due to Postdated pregnancy

Tab. Thyrox 100 mcg/day

Tab. Sardopa 250 mg TDS

Tab. labeta 200mg BD

BP: 170/110mmg Urine bedside: 3+

05/01/23 5Dr Namkha Dorji, Resident, OBGYN, BSMMU

Discordant Twin

LUCS with BLTL

T 1 in breech, male, 3 kgT2 in Transverse lie, male,

1.8 kgTwo placentas and two

membranes

05/01/23 6Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 4

• Name: Mrs. Shamima Begum • Age: 36 year• Para: (2+0)• Gravida: 3rd

• Diagnosis:

3rd gravida at 35+5 weeks pregnancy with APH due to central placenta praevia with p/h/o one LUCS.

P1: NVDP2: LUCS(2011) ? Fetal Distress

USG:Anterior placenta extending up to os

and covering it

05/01/23 7Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 5

• Name: Mrs. Swapna Begum • Age: 21 year• Para: (0)• Gravida: 1st

• Diagnosis:

Echo: Mitral valve-0.8cm3,PASP 98

mmHgDrugs:Tab Pen VK 250 mg BDTab Lasix 20 mg ODTab Labeta 200 mg BDNVD: male, 1.4 kg

Primi at 32+2 weeks pregnancy in preterm labour with chronic rheumatic heart disease (severe MS, Gr IV TR, severe pulmonary HTN and NYHA-Grade II)

05/01/23 8Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 6

• Name: Mrs. Lima • Age: 25 year• Married for: 1 year• Para: [0]• Gravida: 1st

• Diagnosis: Primi at 29+ weeks pregnancy with multiple fetal congenital anomalies with severe oligohydroamonios

USG

•AFI: almost nil•Huge ascitis, short long bones, Hydronephrosis, Hydrocele

05/01/23 9Dr Namkha Dorji, Resident, OBGYN, BSMMU

Medical Termination of Pregnancy

• MTP with PGE2 gel• Male• 1.5 kg• Huge ascitis• Hydrocele• Short long bones

05/01/23 10Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 7• Name: Mrs. Sumoti Rani • Age: 35 year• Para: (2+0)• Gravida: 3rd

• Diagnosis: 3rd gravida at 37+6 weeks pregnancy with dilated cardiomyopathy (NYHA-II) with chronic hypertension with p/h/o one LUCS

Echo:Dilated CM, Dilated LV withBorderline dilated LA, RWMA+ , mod. global hypokinesia with preserved wall thicknessmod LV systolic dysfunction(EF 38%)Mild MR, Trivial TR

P1: NVDP2: LUCS due to PPALC: 4 years

USG:Placenta posterior and away

from osEFW: 2821 gram

AFI: 12 cm

05/01/23 11Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 8• Name: Mrs. Khadiza • Age: 25 year• Married for: 9 years• Para: (1+6)• Gravida: 7th

• Diagnosis:• 7th Gravida at 36+1 week pregnancy with PIH with Rh Isoimmunisation with bad obstetrics history with no living issue.

Anti D anti body

23/9/15 (1: 16)13/10/15 ( 1:64)

P1-3, 5 and 6: abortion between 3 to 6 monthsP4: home delivery and expired at 7 days of age ? Cause of deah- no jaundice.

Wife: A–veHusband: A+ve

Genotyping: Homozygous

ANTI D – not received.

USGAFI: 14 cm

EFW: 2285 gramNo hydropic changes

05/01/23 12Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 9

• Name: Mrs. Taslima • Age: 20 year• Para: [1+1]• Gravida: 3rd

• Diagnosis: 3rd gravida at 32+ weeks pregnancy with preeclampsia with IUGR and oligohydramnios with p/h/o one IUD

USGEFW- 1028 gAFI- 4.7 cm

P1: abortion at 2 months

P2: IUD at 8 months

05/01/23 13Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 10

• Name: Mrs. Afrin • Age: 24 year • Para: (1+0)• Gravida: 2nd

• Diagnosis: 2nd gravida at 36+6 weeks pregnancy with PROM with GDM(on insulin) with Preeclampsia with p/h/o one LUCS

P1: LUCS ALC 6 year

BP and Blood sugar under control:• Inj. Actrapid 8+8+6• Tab Sardopa 250 mg TDS• Tab Labeta 100mg BD

05/01/23 14Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 11

• Name: Dr Shireen • Age: 32 year• Para: (1+1)• Gravida: 3rd

• Diagnosis: 3rd gravida at 37+5 weeks pregnancy in active labour with fetal distress with p/h/o one LUCS

P1: MTP at 25 weeks due to intracranial posterior fossa tumour

P2: LUCSALC: 3 years

05/01/23 15Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 12

• Name: Mrs. Sajeeda• Age: 35 year• Para: (1+0)• Gravida: 2nd

• Diagnosis:

2nd gravida at 37+3 weeks pregnancy with fetal distress with preeclampsia with p/h/o one LUCS

P1: LUCS due to severe preeclampsiaALC: 6 years

USGCephalic presentationEFW: 3100 gramsPlacenta: fundal AFI: 9.15 cm

BP controlled byTab. Sardopa 250 mg TDS

05/01/23 16Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 13

• Name: Mrs. Sumi• Age: 26 year• Para: (1+0)• Gravida: 2nd

• Diagnosis: 2nd gravida at 37+4 weeks pregnancy in active labour with scar tenderness with p/h/o one LUCS with Hypothyroidism and GDM on Insulin.

05/01/23 17Dr Namkha Dorji, Resident, OBGYN, BSMMU

P1: LUCS due to prolonged labour

ALC: 6 year

LUCS findings:Partial uterine ruptureLive fetus

Case 14

• Name: Mrs. Rokeya• Age: 32 year• Para: (2(NVD)+0)• Gravida: 3rd

• Diagnosis: 3rd gravida at 38+ weeks pregnancy with space occupying lesion in right lobe of liver.

05/01/23 18Dr Namkha Dorji, Resident, OBGYN, BSMMU

USG:•Enlarged liver•Lobulated mixed echogenic mass in right lobe (14*13cm)• serum alpha FP : 86.69 ng/ml• other LFT & viral markers - normal

Clinically:•No icterus•Hepatomegally present.

Case 15

• Name: Mrs. Suborna • Age: 23 year• Married for: 3 years • Para: Primi• Gravida: 1st

• Diagnosis: Primi at 38+6 weeks pregnancy with fetal distress

? Fetal distress!Reduced fetal movementNon reactive CTG

05/01/23 19Dr Namkha Dorji, Resident, OBGYN, BSMMU

Non reactive CTG • HR- 140bpm• Variability Reduced• Acceleration Absent• Deceleration Absent

05/01/23 Dr Namkha Dorji, Resident, OBGYN, BSMMU 20

Case 16• Name: Mrs. Farida Yasmin• Age: 31 year• Para: (0+I)• Gravida: 2nd

• Diagnosis:

2nd gravida at 38+ weeks pregnancy with GDM on insulin.

P1: complete abortion at 2 months (2013)

05/01/23 21Dr Namkha Dorji, Resident, OBGYN, BSMMU

Case 17

• Name: Mrs. Israt Karim• Age: 29 year• Married for: One year• Para: (0)• Gravida: primi

• Diagnosis: Primigravida at 38+3 weeks pregnancy with fibroid uterus.

05/01/23 22Dr Namkha Dorji, Resident, OBGYN, BSMMU

LUCS with Myomectomy done:Female baby

3.1 kgIntramural fibroid (8*7 cm) in the lower

segment of anterior wall.

Case 18

• Name: Mrs. Rehana • Age: 28 year• Married for: 4 years • Para: (0)• Gravida: 1st

• Diagnosis: Primigravida at 36+3 weeks pregnancy with IUGR with

hypothyroidism with h/o primary subfertility.

05/01/23 23Dr Namkha Dorji, Resident, OBGYN, BSMMU

Biochemically euthyroid onTab Thyrox 150 microgram daily.

USG on 03/10/2015 Cephalic presentation

AFI: 7.2 comEFW: 1547 cm

Case 19

• Name: Mrs. Jesmin Akter • Age: 34 year• Married for: 2 years • Para: (0)• Gravida: 1st

• Diagnosis: Primigravida at 33+3 weeks pregnancy with APH with

hypothyroidism and bronchal asthma.

05/01/23 24Dr Namkha Dorji, Resident, OBGYN, BSMMU

Biochemically euthyroid onTab Thyrox 50 microgram daily.

USG on 09/09/2015 Cephalic presentation

AFI: 14 comPlacenta: posterior and away from os

Case 20

• Name: Mrs. Parveen • Age: 42 year• Para: 3(NVD)+3(1MR+2 MC)• Gravida: 7th

• Diagnosis: 7th gravida at 34+1 weeks of pregnancy with eclampsia.

05/01/23 25Dr Namkha Dorji, Resident, OBGYN, BSMMU

On admission:BP= 180/110 mmHgUrine albumin= 4 +

Management: Inj. MgSO4 administered

Emergency LUCS and BLTL doneFemale baby weighing 2100 gram

Patient Stable

Case 21

• Name: Mrs. Narun Nahar • Age: 26 year• Para: (2+0)• Gravida: 7th

• Diagnosis: 3rd gravida at 24+6 weeks triplet pregnancy (MAMC) with

polyhydramnios with maternal distress

05/01/23 26Dr Namkha Dorji, Resident, OBGYN, BSMMU

2 NVD- one alive (6 year)Other died at 1 and ½ year due to ? Autistic Disorder

Natural conception USG (MAMC) on 10/10/15

T1: 326 g, T2: 332 g, T3: 300 g.AFI: ?

Case 22

• Name: Mrs. Rima Khatun• Age: 18 year• Para: (0+1 MR)• Gravida: 2nd

• Diagnosis: 2nd gravida at 37+ pregnancy with multiple fetal congenital

anomalies( hydrocephalus and right renal cyst)

05/01/23 27Dr Namkha Dorji, Resident, OBGYN, BSMMU

Unplanned pregnancyNo preconceptional

counselling

USGCephalic presentation

lateral ventricles dilated (right= 49.7 mm & right=38mm)

BPD= 100 mm. AFI= 16 mmCystic area in right kidney(70*60 mm)

05/01/23 28Dr Namkha Dorji, Resident, OBGYN, BSMMU