ZIAUDDIN COLLEGE OF PODIATRIC MEDICINE

PBL
1 Year DPM Batch –III Semester-I
st
Date: 20-02-2023
Module Name: Introduction to Medical Sciences

“Is my baby okay?”

A 35-year-old female, married for 5 years, primigravida with LMP 7 weeks back, came to emergency department
with the complaints of excessive nausea and frequent episodes of vomiting along with lightheadedness since
morning. On history she informed that she had similar episodes on and off for the last few days. On further
inquiry she informed that she was given medicine for ovulation induction (Tab. Clomiphene citrate) without
proper counselling and discussing other treatment modalities. Two weeks back her urinary βhCG was positive.
General Physical Examination:
A young patient looking pale, lethargic, and dehydrated but well oriented in time and space.
Vitals:
BP: 90/60 mmHg
Pulse: 120 bpm
Height: 5 feet 2 inches
Weight: 80kg
Temperature: 98.6 oF
R/R: 24/min
Anemia: present
Jaundice: absent
Clubbing: Not present
Cyanosis: Not present
Edema: Not present
Lymph nodes: Non palpable
Thyroid: Not enlarged

Systemic Examination:
HEENT: Not Significant
Respiratory system: Normal vesicular breathing
Cardiovascular system: S1 & S2 audible with
no added sound .
Abdomen: Soft, non-tender with gut sounds audible
and no visceromegaly
CNS: Well oriented in time, place, and person.
Musculoskeletal: Not significant

Blood Investigation:
CBC
Hb: 10 gm/dl
Hematocrit: 32%
Electrolytes:
Na+: 132 mEq/L
K+: 3.2 mEq/L
Cl-: 106 mEq/L
HCO3-: 23 mEq/L
Serum β hCG:
150000 mIU/mL
Ultrasound Pelvis:

After taking the informed consent, ultrasonography of pelvis was done as shown in the picture.
She was hospitalized and was given IV fluids and antiemetics. Her condition improved and she was discharged
after 2 days with advice to come for follow up after 2 weeks.

TASK:
Discuss the pathophysiology of the above sign and symptoms.
Discuss the anatomical basis of the development of the above scenario.