26-year-old Sana, a housewife from Orangi Town, Karachi, presented to the Emergency Obstetrics

Department of Civil Hospital Karachi on May 1, 2023, with complaints of heavy vaginal bleeding and
severe abdominal pain. She is G5P4+0, with four living children, all delivered vaginally.

Antepartum: 1st trimester: The patient did not seek any antenatal care during the first trimester. 2nd
trimester: She started experiencing severe nausea and vomiting during the second trimester, which
caused her to miss some of her daily meals.

3rd trimester: She complained of lower abdominal pain and increased vaginal discharge in the third
trimester, but her family did not seek medical care due to financial constraints.

Intrapartum: Sana was brought to the hospital in active labor. After that, she had a spontaneous rupture
of membranes. She was taken to the labor room for a vaginal delivery. However, due to severe fetal
distress, an emergency cesarean section was performed. She delivered a stillborn male fetus weighing
2.5 kg.

Postpartum: After the delivery, Sana developed postpartum hemorrhage due to uterine atony and
required blood transfusion. She also developed a fever and was diagnosed with endometritis. She was
treated with antibiotics and her condition improved.

Past Obstetric History: All her previous deliveries were uneventful, with no complications during
pregnancy, labor, or delivery.

Gynecologic history: Menarche at the age of 12. She has a history of irregular menstrual cycles with
excessive bleeding and dysmenorrhea. She has never had a Pap smear or any other gynecological
examination.

Past medical history: Not significant.

Family history: She is married to her first cousin, and there is a history of stillbirth and neonatal deaths in
the family. No other significant medical history in the family.

Personal history: She has a low socioeconomic status and lives in a small house with her husband and
four living children. Her husband is a daily wage laborer and is the sole breadwinner of the family. They
do not have access to clean drinking water or proper sanitation facilities.

Socioeconomic history: She has not received any formal education and is illiterate. Her family cannot
afford to pay for her medical expenses, and she relies on government hospitals for treatment.