General Data

 M.R.
 27y/o
 Female
 Married
 Manila
 Roman Catholic
 Filipino
 Informant: patient
 Date of admission: September 30, 2010
 Chief Complaint

 Scheduled repeat caesarean section

 History of Present Illness

 G3P2(1101)

 LMP: January 13, 2010

 EDC: October 20, 2010

 AOG: 37 1/7 weeks

At 25 weeks AOG, fetal hydrocephalus was seen

on ultrasound
 History of Present Illness
 Few hours PTA
 Patient came in for a scheduled repeat
caesarean section
 No other symptoms noted
 Good fetal movement

Admission
Review of Systems
 (-) weight loss , (-) easy fatigability
 (-) rashes (-) hair loss (-) bruising, (-)pruritus, (+) jaundice
 (-) headache, (-) dizziness, (-) injury
 (-) visual difficulties, (-) excessive lacrimation
 (-) eye or ear discharge, (-) epistaxis, (-) nasal congestion
 (-) mouth sores, fissures, (-) bleeding
 (-) neck stiffness, (-) limitation of motion
 (-)cough, (-) colds, (-) sputum production, (-) chest wall abnormality
 (-)chest pain, (-) easy fatigability, (-) nocturnal dyspnea, (-) syncope, (-)edema, (-)
hypertension
 (-) heat/cold intolerance (-) polyphagia, polyuria, polydypsia
 (-) pain in bone, (-) joint pain (-) limitation of motion
 (-) hallucinations
 (-) cyanosis, (-) edema
 Past Medical History

 (-)hypertension

 (-)diabetes mellitus

 (-) asthma

 (-) allergies

 (-) thyroid problems

 (-) heart disease

Menstrual and Obstetric History

 Menstrual History

Menarche- 12yo

Interval: 28-30 days

Duration: 3-5 days

Amount- 3-4 pads per day, moderately soaked

Signs and Symptoms: (-) dysmenorrhea, (-)

dyspareunia
Menstrual and Obstetric History

 Obstetric History

G3P2 (1-1-0-1)
 G1- 2005- preterm- boy- CS- Fabella- placenta
previa, non-reassuring fetal status- died after 3 days
 G2- 2008- full term- boy- CS- CGH
 G3- present pregnancy

 Regular prenatal check-up

 25 weeks AOG- fetal hydrocephalus
 Family History

 (+)hypertension- father

 (-) diabetes mellitus

 (-) heart disease

 (-) thyroid disease

 (-) congenital anomalies

 Personal and Social History

 Mixed diet

 Non-smoker

 Non-alcoholic drinker

 Denies illicit drug use

Physical Examination
 Conscious, coherent, , not in cardiorespiratory distress

 Vital signs: BP 110/70 PR 84, regular RR 20, regular, T 36.7°C

 Warm, moist skin, no active dermatoses

 Pink palpebral conjunctivae, anicteric sclera, pupils 2-3mm ERTL

 No tragal tenderness AU, non-hyperemic external auditory canal

AU, intact TM AU
 Moist buccal mucosa, tongue midline, non-hyperemic PPW,
tonsils not enlarged,
 Physical Examination

 Supple neck, thyroid gland not enlarged, no

palpable cervical lymph nodes
 Symmetrical chest expansion, no retractions, clear
breath sounds, equal tactile and voice fremiti
 Adynamic precordium, AB at 5th LICS MCL, no
heaves, lifts, thrills, no murmurs
 Physical Examination
 Globular abdomen, (+) striae, normoactive bowel
sounds, soft, no masses, no tenderness, FH 35cm
LM1 cephalic LM3 breech
LM2 fetal back left LM4 cephalic prominence left
 Pulses full and equal, no cyanosis, no edema
 No deformities on all extremities
 IE: cervix- soft, long, closed
uterus: enlarged appropriate for gestational age
adnexa: no mass, no tenderness
 Neurological Examination
 Alert, awake, oriented to 3 spheres GCS 15 (E4V5M6)
 Cranial nerves
 No anosmia
 Pupils 2-3mm ERTL, no ptosis, no visual field cuts
 EOM full and equal
 V1V2V3 intact, can clench teeth
 No facial asymmetry, can smile, frown, raise eyebrow, puff cheeks
 Uvula midline on phonation
 Can shrug shoulders, can turn head against resistance
 Tongue midline on protrusion
 MMT: 5/5 on all extremities
 Can do APST, FTNT with ease
 DTRs ++ on all extremities
 No sensory deficit
 No Babinski
 No nuchal rigidity, Brudzinski, Kernigs
 Assessment

 Gravida 3 Para 2(1101) Pregnancy uterine 37 1/7

weeks AOG, breech not in labor, fetal
hydrocephalus; Previous low transverse caesarean
section secondary to placenta previa and non-
reassuring fetal status
 Principle of Non-maleficence

 Requires the physician to prevent or minimize harm

to patients in the course of physician-patient
interaction
 Principle of Human Dignity

 Requires that all health care decisions must aim to

promote human dignity and result not only in
physical health but also satisfy the patient’s
psychological, social, spiritual and cultural needs as
an individual and as a member of the larger
community to which he belongs
Principle of a Well Formed Conscience

 Requires the physician as responsible health care

providers, when faced with ethical questions including
health care decisions have the following obligations:
 Inform themselves as fully as possible about evidence-
based medical facts and ethical norms
 Form a morally certain judgment of conscience based
on above information
 Make health care decisions according to this fully
informed conscience
 Accept responsibility for their actions
Principle of Professional Communication

 Establish and preserve trust in their patients

 Share medical facts they possess that are

legitimately needed by patients to have an
informed conscience
 Refrain from lying or providing misinformation

 Keep secret information not legitimately needed by

others that if revealed will harm patients or destroy
patient’s trust