Antepartum Haemorrhage

Lee Pei Shin Group B1

Patient Profile• Name : Pn. Syahirah Zainudin• Age : 25 yrs old• Parity : G2P0+1

• Last Menstrual Period: 15/09/2010• Estimated Date of Delivery: 22 /06/2011• Period of Gestation: 37weeks 5 days

• Date of Admission: 11/05/2011• Date of examination: 06/06/2011

Chief Concern

Patient was admitted into ward for bed rest following an episode of bleeding per vagina

History of Presenting IllnessOn 11th May 2011 at 8am, she was awaken by a

sudden mild cramp-like pain below the umbilicus with pain score of 2/10. Pain was continuous and did not increase in intensity nor it radiated. She noticed her half of her pad was stained with fresh blood.

She immediately came to Melaka Hospital and was admitted. There was no signs and symptoms of labour. Fetal movement was perceived at that time and USG was done. Scan had shown a low lying placenta. CTG was also done and patient was told that her baby is in a good condition.

She was monitored with pad chart; 3 pads were changed during that episode. Then the bleeding and pain stopped at noon. She was advised to take bed rest and was monitored in ward. Second episode of bleeding occurred at 8pm on the same day with the similar type of pain and bleeding per vagina but only one and half pad was soaked with fresh blood before it stopped spontaneously. Fetal movement was perceived at that time.

She was told by doctor that she has a low lying placenta but it did not obstruct the internal os as it was a type 2.She was given dexamethasone injection 12mg b.d. She will be scheduled for LSCS and was informed of the risk of the operation.

Currently, patient feels worried about the complication of the operation and the wellbeing of baby once delivered. She wants to stay in hospital till date of operation because she fears she will lose her baby.

History of Presenting Pregnancy

Pregnancy was planned and confirmed by urine pregnancy test at 1 month of period of gestation. Booking was done immediately at Klinik Desa Bukit Katil. She was given hematinics which she was compliant to. She goes for regular antenatal check up. Anomaly scan was done at 20 weeks and fetus is normal. Up till 5th month, her pregnancy was uneventful.

At 5th month of pregnancy, she was told that she has gestational diabetes mellitus. Her fasting blood glucose level was initially 7.8mmol/L and was advised to control her diet and it dropped to 6.9mmol/L. No history suggestive of hypoglygemic episodes. Currently, her fasting blood glucose level is 7.0mmol/L and well controlled with diet restriction.

Obstetric History

Patient is married for 2 years. She has a history of miscarriage in 2010. She was 3rd month into her pregnancy and it was an incomplete miscarriage. Dilatation and curettage operation was done then.

Menstrual History

Patient attained menarche at 11 years old. She has regular cycles with no dysmenorrhea. No oral contraceptive taken. Pap smear was done last year and results was normal.

Past History

There is no significant medical history.No history of previous surgeries.No known drug allergy.

Family History

Patient’s father and mother is both living and healthy. No history of diabetes, hypertension, heart disease or genetic disorders.

Personal History

Sleep, appetite, bowel and bladder habits are normal. She is a non-smoker, non-drinker and no illicit drug abuse. Husband is a smoker and smokes near patient at times.

Social History

Patient lives with her husband in Bukit Katil about 20 minutes from hospital. Her husband is a factory worker and she is a housewife. Total family income is about RM1500.

SUMMARY

25 years old, G2P0+1 ,currently 37 weeks and 5 days of gestation with known gestational diabetis mellitus presented with bleeding per vagina and ultrasound scan shows placenta praevia type 2. Currently, mother and fetus is in good condition, blood sugar level is well controlled and awaiting LSCS to be scheduled.

General Physical Examination

• Alert, conscious,pink• No pallor, oral hygiene good, no lymphadenopathy• Mild bilateral pedal oedema present.• No lumps palpable in both breast, both nipples

normal ( no inverted or cracked nipple)

• Pulse is 80bpm, regular rhythm, normal volume, no special character

• BP is 120/70 mmHg• Temperature is 37oC (afebrile)

Obstetric ExaminationOn inspection, abdominal is

uniformly distended, both flanks are full, umbilicus central and flat,linea nigra and striae gravidarum present. All quadrants move with respiration.No dilated veins and scar seen. Fetal movement is seen.Both hernial orifice intact.

On palpation, fundal height is 34 weeks, symphysiofundal height is 38cm. Fundal grip revealed a soft, broad, non-ballotable mass suggestive of breech. Lateral grip revealed a curved,smooth, continous feeling on the maternal right suggestive of the back and irregular knob like structures were felt on maternal left suggestive of the limbs. Pelvic grip revealed a hard, round,non-ballotable structure which is the head, 4/5th palpable.The presentation is cephalic and liquor is adequate.On auscultation,fetal heart rate was 150bpm.

In summary, a singleton pregnancy, longitudinal lie with cephalic presentation and head 4/5th palpable.

Systemic examination

Respiratory : Bilateral vesicular breath sounds heard equally on both lung.

Cardiovascular: S1 and S2 heard. No murmurs detected.

Provisional Diagnosis

Placenta praevia type 2