CLINICAL PROFILE

SUBMITTED TO, SUBMITTED BY,

Mrs.Smitha Jose Arathy Unnithan

Associate professor 2nd year MSc Nursing
TMM college of Nursing TMM College of Nursing
Thiruvalla Thiruvalla

Submitted on
11/12/2023
 Patient 1 Patient 2 Patient 3

Name of the patient Mrs. Litha Thampi Mrs. vineetha Vijayan Mrs. Rakhi Rajendran
30 years
Age 28 years 27 years

Chirayil veedu
Address Tharayil Kadampattil house
Mepral p.o
Kumarankari Kaviyoor Thiruvalla
Changanassery Thiruvalla
Religion
Hindu
Income Christian Hindu
150000 100000 10000
Mr. Bijin
Husband name Mr Jerrin Mr Sandeep
Blood group of the mother B Positive O positive O positive
A positive
Blood group of the father AB Positive B positive
date of admission` 11/7/2023 21/06/23 11/09/23
Date of discharge 16/07/23 28/06/23
15/09/23
Date of study started 11/07/23 22/06/23 12/09/23
15/09/23
Date of study ended 14/07/23 24/06/23
Obstetrical score G1P0L0A0 G1P0L0A0 G1P0L0A0
LMP 14/11/22 30/08/22
2/01/23
EDD 21/07/23 7/06/23
16/10/23
Reason for admission For safe confinement For safe confinement For safe confinement
Diagnosis Pregnancy induced hypertension Pregnancy induced hypertension Pregnancy induced hypertension

Mrs. Rakhi Rajendran 30 years

OBSTETRICAL HISTORY Mrs. Litha Thampi, 28 years /F Mrs. Vineetha Vijayan 27 years
/F primigravida mother got
primigravida mother got admitted /F primigravida mother got
admitted in TMM hospital
in TMM hospital Thiruvalla and admitted in TMM hospital
Thiruvalla and consulted doctor
consulted doctor Anu and doctor Thiruvalla and consulted doctor
Anu and doctor advised the
advised the patient to take Anu and doctor advised the
patient to take obstetrical scan for
obstetrical scan for the check up patient to take obstetrical scan for
the check up after that the bp was
after that the bp was 130/90mm the check up after that the bp was
150/90mm of hg .On examination
of hg .On examination no pallor , 150/90mm of hg .On examination
no pallor , per abdomen uterus is
per abdomen uterus is firm and no pallor , per abdomen uterus is
firm and relaxed, visible fetal
relaxed, visible fetal movements firm and relaxed, visible fetal
movements are perceived. Fetal
are perceived. Fetal heart rate is movements are perceived. Fetal
heart rate is normal132 beats per
normal132 beats per minutes heart rate is normal132 beats per
minutes
minutes
`
1st TRIMESTER
1st TRIMESTER 1st TRIMESTER
The pregnancy was planned and
The pregnancy was planned and The pregnancy was planned and
confirmed by the urine pregnancy
confirmed by the urine pregnancy confirmed by the urine pregnancy
test. Her first scan was done on
test. Her first scan was done on test. Her first scan was done on
5th week which should confirm
5th week which should confirm 5th week which should confirm
the pregnancy. She started to take the pregnancy. She started to take the pregnancy. She started to take
Tab.flovite 5mg OD from the Tab.flovite 5mg OD from the Tab.flovite 5mg OD from the
fifth week onwards.During the fifth week onwards. During the fifth week onwards. During the
first trimester she had increased first trimester she had increased first trimester she had increased
frequency of frequency of frequency of
micturition ,weakness and micturition ,weakness and micturition ,weakness and
morning sickness such as nausea morning sickness such as nausea morning sickness such as nausea
and vomiting. She completed first and vomiting. She completed first and vomiting. She completed first
dose of T.T on 12th week. dose of T.T on 12th week. dose of T.T on 12th week.

2nd TRIMESTER 2nd TRIMESTER

2nd TRIMESTER
Morning sickness was increased Morning sickness was increased
Morning sickness was increased
and frequency of micturition was and frequency of micturition was
and frequency of micturition was
decreased. The mother was more decreased. The mother was more
decreased. The mother was more
active .She started Tab. shelcal active .She started Tab. shelcal
active .She started Tab. shelcal
500 mg in the morning. She 500 mg in the morning. She
500 mg in the morning. She
gained all the antenatal checkups. gained all the antenatal checkups.
gained all the antenatal checkups.
Anomaly scan was performed at Anomaly scan was performed at
Anomaly scan was performed at
20th week of pregnancy, it was 20th week of pregnancy, it was
20th week of pregnancy, it was
normal. She completed her normal. She completed her
normal. She completed her
second dose of T.T at 18th week. second dose of T.T at 18th week.
second dose of T.T at 18th week.
 3rd TRIMESTER 3rd TRIMESTER
She gained 5 kg weight. She had She gained 5 kg weight. She had
increased urinary frequency, mild increased urinary frequency. She 3rd TRIMESTER
itching, over the abdomen and underwent all the regular She gained 6 kg weight. She had
backache due to the antenatal checkups. increased urinary frequency, mild
overstretching of the abdomen. itching, over the abdomen and
She underwent all the regular backache due to the
antenatal checkups. overstretching of the abdomen.
She underwent all the regular
Mrs. Litha Thampi 28 years Mrs. vineetha Vijayan 27 years antenatal checkups.
has no significant past obstetrical has no significant past obstetrical
Mrs. Rakhi Rajendran 30 years
PASTOBSTETRICAL HISTORY history. history.
has no significant past obstetrical
history.
Mrs. Litha Thampi 28 years Mrs. vineetha Vijayan 27 years
has no significant past medical has no significant past medical
Mrs. Rakhi Rajendran 30 years
PAST MEDICAL HISTORY history. history.
has no significant past medical
history.

Mrs. Litha Thampi 28 years Mrs. vineetha Vijayan 27 years

PRESENT AND PAST has no significant past and has no significant past and
SURGICAL HISTORY
 present history. present surgical history. Mrs. Rakhi Rajendran 30 years
has no significant past surgical
FAMILY HISTORY Mrs. Litha Thampi belongs to a Mrs. vineetha Vijayan belongs to history of appendicitis since
high-class family. Her husband is a high-class family. Her husband 2012.
the bread winner of the family. is the bread winner of the family. Mrs. Rakhi Rajendran belongs to
All the family members are All the family members are a high-class family. Her husband
healthy and are free from all the healthy and are free from all the is the bread winner of the family.
communicable diseases communicable diseases All the family members are
healthy and are free from all the
communicable diseases
PERSONAL HISTORY Mrs Litha Thampi lives with her Mrs vineetha Vijayan lives with
husband. She is well nourished her husband. She is well
and likes non vegetarian nourished and likes non Mrs Rakhi Rajendran lives with
food .She has adequate rest and vegetarian food . She has her husband. She is well
sleep but sometimes sleeping adequate rest and sleep but nourished and likes non
pattern is disturbed due to sometimes sleeping pattern is vegetarian food . She has
hospitalization. She maintains disturbed due to hospitalization. adequate rest and sleep but
good personal hygiene. Her She maintains good personal sometimes sleeping pattern is
Bowel and bladder pattern was hygiene. Her Bowel and bladder disturbed due to hospitalization.
regular . She has no any bad pattern was regular. She has no She maintains good personal
habits like smoking, chewing, etc any bad habits like smoking, hygiene. Her Bowel and bladder
chewing, etc. pattern was regular. She has no
 any bad habits like smoking,
MENSTRUAL HISTORY chewing, etc.
Age of menarche 16 Years 15 Years
Frequency and duration 28 days and 4-5 days 28 days and 5-7 days
Amount of blood 3-4 pads/ day 3-4 pads/ day 14 Years
Any Abnormalities no any abnormalities in no any abnormalities in 30 days and 4-5 days
menstruation menstruation 3-4 pads/ day
no any abnormalities in
MARITAL HISTORY menstruation

Age of marriage 27 25
Type of marriage Non consanguineous Non consanguineous
Years of marriage 1 year 2 years 28
Use of contraceptives nil Nil Non consanguineous
2 years
SOCIO ECONOMIC STATUS Nil
Place of housing rural rural
Occupation accountant engineer
House own own Rural
PHYSICAL EXAMINATION Nurse
General Appearance own
Body built: Moderate Moderate
Nourishment: Nourished Nourished
Activity: Active Dull Moderate
Skin Nourished
Colour: White White Dull
Texture: Normal skin Normal skin
Lesions: No lesions No lesions White
Head Normal skin
Scalp: Clean Clean No lesions
Hair: Black Black
Eyes Clean
Eyebrows: Evenly distributed Evenly distributed Black
Eyelids: No edema No edema
Conjunctiva Pale in colour Pale in colour Evenly distributed
Sclera: White in colour White in colour No edema
Vision Normal visual activity Normal visual activity Pale in colour
White in colour
Normal visual activity

Ear
External ear: No discharge or bleeding No discharge or bleeding
Hearing: Good hearing activity Good hearing activity
Nose No discharge or bleeding
Nasal septum: No deviation No deviation Good hearing activity
External nose: No discharge or bleeding No discharge or bleeding
Mouth No deviation
Teeth: No dentures are present No dentures are present No discharge or bleeding
Neck
All movements are possible with All movements are possible with No dentures are present
neck neck
Thyroid gland Not enlarged Not enlarged All movements are possible with
neck
Respiratory system Not enlarged
Inspection: Normal size and shape Normal size and shape
Absence of use of accessary Absence of use of accessary
Muscle Muscle Normal size and shape
Palpation No nodules and masses No nodules and masses Absence of use of accessary
Percussion No fluid collection No fluid collection Muscle
Auscultation Normal lung sounds Normal lung sounds No nodules and masses
No fluid collection
Cardiovascular system Normal lung sounds
Inspection Normal size and shape Normal size and shape
 No visible pulsation No visible pulsation
Absence of scar or trauma Absence of scar or trauma Normal size and shape
Palpation: No tenderness No nodules or No tenderness No nodules or No visible pulsation
Auscultation masses S1, S2 heard normal masses S1, S2 heard normal Absence of scar or trauma
Heart rate 88 beats/ min 86 beats/ min No tenderness No nodules or
masses S1, S2 heard normal
Musculoskeletal system 78 beats/ min
Upper extremities: ROM possible ROM possible
Capillary refill 3 sec Capillary refill 3 sec
No cyanosis and edema No cyanosis and edema ROM possible
Lower extremities: Edema absents Edema absents Capillary refill 3 sec
ROM possible ROM possible No cyanosis and edema
Edema absents
Neurological system ROM possible
Level of consciousness: Fully conscious Fully conscious
Orientation: Oriented to time, place and Oriented to time, place and
Motor system: person Normal muscle tone, person Normal muscle tone, Fully conscious
Sensory system: strength Sensitive to touch, pain strength Sensitive to touch, pain Oriented to time, place and
and temperature and temperature person Normal muscle tone,
Genitourinary system strength Sensitive to touch, pain
Vulva Edematous Edematous and temperature
Varicosities: Absent Absent
Discharge: White discharge present White discharge present Edematous
Frequency of micturition: Increased Increased Absent
Bowel movements Opened Opened White discharge present
Increased
ANTENATAL EXAMINATION Opened
ABDOMEN
 INSPECTION
appropriate for the gestational appropriate for the gestational
Size
age age
Contour
convexity of abdomen present convexity of abdomen present appropriate for the gestational
Shape
ovoid in shape ovoid in shape age
Fetal movements
visible visible convexity of abdomen present
Umbilicus
protruded protruded ovoid in shape
Skin changes
linea nigra and straie gravidarum linea nigra and straie gravidarum visible
present present protrudedlinea nigra and straie
 PALPATION
gravidarum present
Abdominal girth
Height of the fundus 98 cm 102 cm
Fundal palpation 36 in weeks and 34 in cm 37in weeks and 36 in cm
soft broad irregular mass soft broad irregular mass 98 cm
suggestive of fetal buttocks
 suggestive of fetal buttocks 36 in weeks and 35 in cm
Lateral palpation Right –irregular knob like feel soft broad irregular mass
suggestive of fetal limbs Right –irregular knob like feel suggestive of fetal buttocks
Left – smooth curved resistant suggestive of fetal limbs
feel suggestive of fetal spine Left – smooth curved resistant Right –irregular knob like feel
PELVIC GRIP feel suggestive of fetal spine suggestive of fetal limbs
At pelvis smooth hard globular mass Left – smooth curved resistant
suggestive of fetal head smooth hard globular mass feel suggestive of fetal spine
Occipital pole above the pelvic brim suggestive of fetal head
Syncipital pole above the pelvic brim above the pelvic brim smooth hard globular mass
Converging/diverging diverging above the pelvic brim suggestive of fetal head
Descent of the presenting part 5/5 diverging above the pelvic brim
5/5 above the pelvic brim
 PAWLIK GRIP diverging
5/5
Size appropriate for the gestational
age appropriate for the gestational
Flexion flexed age
Mobility movable flexed appropriate for the gestational
movable age
 COMBINED GRIP flexed
movable
At fundus podalic
At pelvis cephalic podalic
cephalic
podalic
 AUSCULTATION
cephalic
FHS 148 beats per min
152 beats per min
FINDINGS
148 beats per min
Gestational age 36 weeks
Lie longitudinal lie 37 weeks
Presentation cephalic longitudinal lie
36 weeks
Position LOA cephalic
longitudinal lie
Attitude flexion LOA
cephalic
Descent of the presenting part 5/5 flexion
LOA
Engagement not engaged 5/5
flexion
FHS 148 beats per minute not engaged
5/5
152 beats per minute
not engaged
142beats per minute

INVESTIGATIONS
13.9
Hemoglobin 12.9
36.9
 PCV 9900 36.9 12.0
WBC count 4.24 9000 35.8
RBC count 4.24 9800
68 4.24
Poly 26 66
Lymph 2 28 68
Esino 1 1 26
Mono 89 1 2
Mcv 39 86 0
Mch 34 38 89
Mchc 16 33 39
RDW 224 14 34
Platelet count 227 16
URINE EXAMINATION Light yellow 232
Colour Clear Light yellow
Apperence 5.5 Clear Light yellow
PH 1.030 5.3 Clear
specific gravity Neg 1.030 5.1
glucose Neg Neg 1.032
protein + Neg Neg
ketones Negative + Neg
 bilirubin Negative +
Negative
DISEASE CONDITION
INTRODUCTION
Hypertension is one of the
common medical complications
of pregnancy and contributes
significantly to maternal and
perinatal morbidity and mortality.
Hypertension is a sign of an
underlying pathology, which may
be pre-existing or appears for the
first time during pregnancy. The
identification of this clinical
entity and effective management
play a significant role in the
outcome of pregnancy, both for
the mother and the baby. In
developing countries, with
inadequately cared pregnancy,
this entity on many occasions
remains undetected till major
complications supervene.
DEFINITION:
Preeclampsia is a multisystem
disorder of unknown etiology
characterized by development of
hypertension to the extent of
140/90 mm Hg or more with
proteinuria after the 20th week in
a previously normotensive and
nonproteinuric woman. Some
amount of edema is common in a
normal pregnancy. Edema has
been excluded from the
diagnostic criteria unless it is
pathological. The preeclamptic
features may appear even before
the 20th week as in cases of
hydatidiform mole and acute
polyhydramnios.
Risk factors
 Primigravida: Young or
elderly (first time
 exposure to chorionic
villi)
 Familyhistory:
Hypertension, Family history of hypertension
preeclampsia Family history of hypertension
 Placental abnormalities:
 Hyperplacentosis:
Excessive exposure to
chorionic villi— (molar
pregnancytwins,
diabetes)
 Placental ischemia.
 Obesity: BMI >35 kg/m2
, Insulin resistance.
 Pre-existing vascular
disease .
 New paternity
 Thrombophilias
[antiphospholipid
syndrome, protein C, S
defi ciency, Factor V
 Leiden

CLINICAL TYPES
The clinical classification of
preeclampsia is arbitrary and is
principally dependent on the level
of blood pressure for
management purpose. But
proteinuria is more significant
than blood pressure to predict
fetal outcome.

Mild: This includes cases of

sustained rise of blood pressure Patient have mild hypertension
of more than 140/90 mm Hg but Patient have mild hypertension
less than 160 mm Hg systolic or Patient have mild hypertension
110 mm Hg diastolic without
significant proteinuria.

Severe: (1) A persistent systolic

blood pressure above or equal to
160 mm Hg or diastolic pressure
above 110 mm Hg. (2) Protein
excretion of more than 5 g/24 h
(3) Oliguria.
CLINICAL FEATURES
SYMPTOMS: Preeclampsia is
principally a syndrome of signs
and when symptoms appear, it is
usually late.
Mild symptoms: Slight swelling
over the ankles which persists on
rising from the bed in the
morning or tightness of the ring
on the finger is the early
manifestation of edema due to
preeclampsia. Gradually, the
swelling may extend to the face,
abdominal wall, vulva and even
the whole body.
Alarming symptoms: The
following are the ominous
symptoms, which may be evident Patient have head ache ,disturbed
either singly or in combination. Patient have head ache , disturbed
These are usually associated with sleep and epigastric pain sleep
acute onset of the syndrome. (1) Patient have head ache ,disturbed
Headache — either located over sleep
the occipital or frontal region, (2)
Disturbed sleep,(3) Diminished
urinary output— Urinary output
of less than 400 mL in 24 hours is
very ominous, (4) Epigastric pain
—acute pain in the epigastric
region associated with vomiting,
at times coffee color, is due to
hemorrhagic gastritis or due to
subcapsular hemorrhage in the
liver, (5) Eye symptoms—there
may be blurring, scotomata,
dimness of vision or at times
complete blindness. Vision is
usually regained within 4–6
weeks following delivery. The
eye symptoms are due to spasm
of retinal vessels (retinal
infarction), occipital lobe damage
(vasogenic edema) or retinal
detachment. Reattachment of the
retina occurs following
subsidence of edema and
normalization of blood pressure
after delivery.
SIGNS
1. Abnormal weight gain:
Abnormal weight gain within a
short span of time probably
appears even before the visible
edema. A rapid gain in weight of
more than 5 lb a month or more
than 1 lb a week in later months
of pregnancy is significant.
2. Rise of blood pressure: The
rise of blood pressure is usually
insidious but may be abrupt. The
diastolic pressure usually tends to
rise first followed by the systolic
pressure.
3. Edema: Visible edema over the
ankles on rising from the bed in
the morning is pathological. The
edema may spread to other parts
of the body in uncared cases .
Sudden and generalized edema
may indicate imminent
eclampsia.
4. There is no manifestation of
chronic cardiovascular or renal
pathology.
5. Pulmonary edema—due to
leaky capillaries and low oncotic
pressure. 6. Abdominal
examination may reveal
evidences of chronic placental
insufficiency, such as scanty
liquor or growth retardation of
the fetus.

iNVESTIGATIONS
Urine: Proteinuria is the last
feature of preeclampsia to appear.
It may be trace or at times
copious so that urine becomes
solid on boiling (10–15 g/L).
There may be few hyaline casts,
epithelial cells or even few red
cells. 24 hours urine collection
for protein measurement is done
(see above).
Ophthalmoscopic examination:
In severe cases there may be Urine and blood examination Urine and blood examination
retinal edema, constriction of the done inpatient done inpatient
arterioles, alteration of normal Urine and blood examination
ratio of vein: arteriole diameter done inpatient
from 3 : 2 to 3 : 1 and nicking of
the veins where crossed by the
arterioles. There may be
hemorrhage.
Blood values: The blood changes
are not specific and often
inconsistent. A serum uric acid
level (biochemical marker of
preeclampsia) of more than 4.5
mg/dL indicates the presence of
preeclampsia. Blood urea level
remains normal or slightly raised.
Serum creatinine level may be
more than 1 mg/dL. There may
be thrombocytopenia and
abnormal coagulation profile of
varying degrees. Hepatic enzyme
levels may be increased.
Antenatal fetal monitoring:
Antenatal fetal well-being
assessment is done by clinical
examination, daily fetal kick
count, ultrasonography for fetal
growth and liquor pockets,
cardiotocography, umbilical
artery flow velocimetry and
biophysical profile

Complications of
PREECLAMPSIA
The complications are more
likely to occur if the patients are
left untreated and uncared for.

 Immediate:
 Maternal
 Fetal
 Remote
IMMEDIATE: Maternal t During
pregnancy: (a) Eclampsia (2%)
— more in acute than in subacute
cases, (b) Accidental hemorrhage,
(c) Oliguria and anuria, (d)
Dimness of vision and even
blindness, (e) Preterm labor, (f)
HELLP syndrome (g) Cerebral
hemorrhage, (h) Acute respiratory
distress syndrome (ARDS) t

During labor: (a) Eclampsia, (b)

Postpartum hemorrhage — may
be related with coagulation
failure

Puerperium: (a) Eclampsia —

usually occurs within 48 hours,
(b) Shock— puerperal vasomotor
collapse is associated with
reduced concentration of sodium
and chloride due to sudden fall in
corticosteroid level, (c) Sepsis—
due to increased incidence of
induction, operative interference,
and low vitality. Fetal: The fetal
risk is related to the severity of
preeclampsia, duration of the
disease and degree of proteinuria.
The following hazards may
occur.(a) Intrauterine death—due
to spasm of uteroplacental
circulation leading to accidental
hemorrhage or acute red
infarction, (b) Intrauterine growth
restriction— due to chronic
placental insufficiency, (c)
Asphyxia, (d) Prematurity—
either due to spontaneous preterm
onset of labor or due to preterm
induction

Management OF
PREECLAMPSIA
So long as the etiology of
preeclampsia remains obscure,
the treatment is mostly empirical
and symptomatic. While
measures are directed to relieve
edema and hypertension, there is
no specific therapy for
proteinuria which automatically
subsides with the control of
hypertension.
Objectives are:
(1) To stabilize hypertension and
to prevent its progression to
severe preeclampsia.
(2) To prevent the complications
(3) To prevent eclampsia.
(4) Delivery of a healthy baby in
optimal time.
(5) Restoration of the health of
the mother in puerperium.
Hospital or home treatment:
Ideally, all patients of
preeclampsia are to be admitted
in the hospital for effective
supervision and treatment. There
is no place of domiciliary
treatment in an established.

HOSPITAL MANAGEMENT
Rest: Admission in hospital and
rest is helpful for continued
evaluation and treatment of the
patient. While in bed patient
should be in left-lateral position
as much as possible, to lessen the
effects of vena caval
compression.
 Rest — (1) increases renal
blood flow → diuresis,
(2) increases uterine
blood flow → improves
placental perfusion, and
(3) reduces the blood Doctor advised to take rest Doctor advised to take rest
pressure. However
completed bed rest is not Doctor advised to take rest
essential.
 Diet: The diet should
contain adequate amount
of daily protein (about
100 g). Usual salt intake
is permitted. Fluids need
not be restricted. Total
calorie approximate 1,600 Salt restricted diet Salt restricted diet
cal/day.
 Diuretics: The diuretics Salt restricted diet
should not be used
injudiciously, as they
cause harm to the baby by
diminishing placental
perfusion and by
electrolyte imbalance.
The compelling reasons
for its use are—(1)
Cardiac failure, (2)
Pulmonary edema, (3)
Along with selective
antihypertensive drug
therapy (diazoxide group)
where blood pressure
reduction is associated
with fluid retention, (4)
Massive edema, not
relieved by rest and
producing discomfort to
the patient. The most
potent diuretic commonly
used is furosemide
(Lasix) 40 mg, given
orally after breakfast for 5
 days in a week. In acute
condition, intravenous
route is preferred (details
in Chapter 34).
 Antihypertensives:
Antihypertensive drugs
have limited value in
controlling blood pressure
due to preeclampsia. The
indications are:
 (1) Persistent rise of blood Anti hypertensive drugs given to Anti hypertensive drugs given to
pressure especially where the patient the patient
the diastolic pressure is Lobet 10 mg Lobet 10 mg Anti hypertensive drugs given to
over 110 mm Hg. The use the patient
is more urgent if Lobet 10 mg
associated with
proteinuria.
(2) In severe preeclampsia, to
bring down the blood
pressure during pregnancy
and labor, the common oral
drugs have been discussed
later. Drug selection depends
on its local availability and
experience of use.

METHODS OF DELIVERY:

 Induction of labor
 Caesarean section