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O&g - Case - Pih, PP
O&g - Case - Pih, PP
Chief complaint
Madam N, 41 years old Malay housewife gravida 8 para 7 currently at 38 weeks of gestation presented with high blood pressure and low lying placenta on the day of admission.
REDD: 11/5/2011 Menstrual history: menarche at 14 years old, regular, 4 7 days in 29 days cycle OCP: for 1 years (1995-1996)
Last pregnancy is 4 years ago. Not having PIH or other problems during past pregnancies. No past gynaecological history. Married at 18 years old until now.
No known long term medical illness including hypertension and diabetes mellitus Never undergoes any surgery Not taking any long term medication No allergy
Family history
Social history
Housewife, living in village house at Kuala Selangor. Never smoking and not consume alcohol. Not take ilicit drug. Husband working as civil contractor and smoke 20 cigarettes per day.
Vital signs
Pulse: 83 bpm, regular rhythm and good volume BP: 113/80 mmHg Temperature: 37C RR: 16 breaths per minute
Physical examinations
Abdomen is distended, umbilicus centrally located and inverted. There is linea nigra and striae gravidarum. There is no scar. Uterus is at 38 weeks, measures 36 cm Single fetus, longitudinal lie, cephalic presentation, head is 5/5th palpable, liquor is adequate and estimates fetal weight is 3.0 kg Fetal heart rate is 148 bpm Systemic examinations: normal
Summary
Madam N, 41 years old Malay housewife gravida 8 para 7 currently at 38 weeks of gestation presented with high blood pressure and low lying placenta on the day of admission.
Diagnosis
Provisional Madam N 41 years old gravida 8 para 7 currently at 38 weeks of gestation having asymptomatic pregnancy induced hypertension and placenta praevia. Differential diagnosis pre eclampsia, eclampsia and chronic hypertension
Investigations
FBC Urine albumin Urine protein 24 hours Uric acid Renal profile Liver function test Coagulation profile Transabdominal scan: shows placenta praevia type 2
Management
Monitor BP 2 hourly T. Methyldopa 500mg tds Plan for elective LCSC Check for features of impending eclampsia Daily urine albumin Monitor pad chart and time contraction FBC weekly CTG once daily
Discussion
PIH Onset BP (mmHg) Urine protein (mg/24 hrs) Risk factors and causes 2nd trimester Pre eclampsia Impending eclampsia Eclampsia Chronic HPT Prior to pregnancy > 120/80 > 20 weeks of gestation 140/90 300
primigravida previous history family history diabetes pre existing hpt multiple gestation
Features
Rx
Ix
HELLP syndrome
Cx
Placenta praevia
Definition
Type
APH & PPH pre term labor caesarean section Complication Risk factor