CASE PRESENTATION

ON
IUGR
BY-DR.MAITRIK PATEL

HOD- DR.B.S.BHATI

MODERATOR- DR.DEEPIKA MA'AM

(GOVT. MEDICAL COLLEGE AND BANGUR HOSPITAL, PALI)

CASE:
• A 22 YRS OLD MRS.PINKY FROM CHANOD , MARRIED FOR 4
YRS ,G1PO , SUSPECTED CASE OF IUGR WITH PIH WAS ADMITTED IN
LABOUR ROOM AT 37WKS 0 DAYS OF GESTATION , SHE'S HOUSEWIFE
BY OCCUPATION , UNEDUCATED , HINDU BY RELEGION BELONGING
TO A POOR SOCIO-ECONOMIC BACKGROUND.
CHIEF COMPLAINTS:
• HEADACHE SINCE 1 WEEK

• SWELLING OVER BODY

• BLURRING OF VISION SINCE 1 DAY.

HISTORY OF PRESENTING ILLNESS:
• PRIMIGRAVIDA WITH 8 AND HALF MONTHS OF AMENORRHOEA
• THERE IS H/O OF HEADACHE SINCE 1 WK WHICH IS , INSIDIOUS IN
ONSET, LOCALISED TO BACK OF THE HEAD MORE INTENSE IN THE
MORNING .
• GENERALIZED SWELLING OVER THE BODY IS PRESENT SINCE 1
MONTH, WITH TIGHTNESS OF THE RING ON THE FINGER.
INITIALLY BELOW ANKLES AND GRADUALLY PROGRESSING TILL KNEE
& WHOLE BODY. IT IS PRESENT THROUGHOUT THE DAY AND NOT
RELIEVED ON TAKING OVERNIGHT REST OR LIMB ELEVATION.
• BLURRING OF VISION SINCE 1 DAY WHICH IS PROGRESSIVE IN
NATURE.
• NO H/O BREATHING DIFFICULTY.
• NO H/O CHEST PAIN.
• NO H/O FEVER.
• NO H/O COUGH & EXPECTORATION.
• NO H/O ORTHOPNEA.
• NO H/O SYNCOPE.
• NO H/O SEIZURES.
• NOT ASSOCIATED WITH VOMITING .
• NO H/O REDUCED URINE OUTPUT , REDDISH DISCOLOURATION OF
URINE.
• NO H/O IRREGULAR MENSES IN PAST.
• NO H/O USING HORMONAL PILLS IN PAST.
OBSTETRIC HISTORY:
• MARITAL HISTORY :
• MARRIED AT THE AGE OF 18 YRS
• ACTIVE MARRIED LIFE- 4 YRS
• NON CONSANGUINEOUS MARRIAGE.
• O/H- G1P0
H/O PRESENT PREGNANCY:
1ST TRIMESTER: 1 VISIT
• CONCEIVED SPONTANEOUSLY AND CAME TO KNOW BY UPT AFTER 1.5
MONTHS OF 1ST MISSED PERIOD.
• H/O NAUSEA AND VOMITING TILL 1ST 3 MONTHS WAS PRESENT.
• NO H/O FEVER WITH / WITHOUT RASH.
• NO H/O BLEEDING PER VAGINA.
• NO H/O BURNING MICTURITION.
• NO H/O VAGINAL DISCHARGE.
• NO H/O RADIATION EXPOSURE.
• NO H/O DRUG INTAKE PRESENT OTHER THAN FOLIC ACID TABLETS
WHICH WERE TAKEN DAILY.
• DATING SCAN WAS DONE AND NT SCAN WAS DONE WERE NORMAL.
• VITALS WERE EXAMINED AND ROUTINE INVESTIGATIONS WERE DONE
AND TOLD TO BE NORMAL.
• 1ST DOSE OF dT WAS GIVEN.
• HER WEIGHT WAS 40 KGS
2ND TRIMESTER: 1 VISIT
• QUICKENING FELT AT 5TH MONTH AND CONTINUED TO PERCIEVE
FETAL MOVEMENTS.
• ANOMALY SCAN WAS DONE AT 5TH MONTH AND TOLD TO BE
NORMAL.
• 2ND DOSE OF dT WAS TAKEN.
• IFA AND CALCIUM TABLETS WERE TAKEN FROM 3 AND HALF MONTHS
OF PREGNANCY.
• BLOOD PRESSURE , BLOOD SUGAR AND OTHER ROUTINE
INVESTIGATIONS WERE DONE AND TOLD TO BE NORMAL.
• NO H/O PEDAL EDEMA.
• NO H/O NAUSEA AND VOMITING
• NO H/O HEADACHE , EPIGASTRIC PAIN , VISUAL DISTURBANCES.
• NO H/O PAIN ABDOMEN , LEAK OR BLEEDING PER VAGINA .
• IN THIS VISIT HER WEIGHT WAS 43KGS.
3RD TRIMESTER: PRESENT VISIT
• FETAL MOVEMENTS WELL PERCEIVED.
• CONTINUED TO TAKE IRON AND CALCIUM TABLETS.
• HAS COME WITH COMPLAINTS OF HEADACHE , SWELLING OVER
BODY, BLURRY VISION .
• WAS ADMITTED DUE TO RAISED BP RECORDING FOR FURTHER
EVALUTIONS.
• NO COMPLAINTS OF ABDOMINAL PAIN , LEAK OR
BLEEDING PER VAGINA .
• IN THIS VISIT HER WEIGHT WAS 48 KGS.
MENSTRUAL HISTORY:
• MENARCHE WAS ATTAINED AT THE AGE OF 13 YRS.
• SHE HAS REGULAR CYCLES OF 28-30 DAYS LONG WITH 3-4 DAYS FLOW
AND USES 1-2 PADS PER DAY.
• DYSMENORRHEA WAS ASSOCIATED.
• NO H/O PASSAGE OF CLOTS.
• LMP- 30/7/22
• EDD- 6/5/23
• POG- 37 WEEKS 0 DAYS
PAST HISTORY:
• THERE IS NO H/O:
-HTN
-DM
- TUBERCULOSIS
-ASTHMA
-THYROID DISEASE
-EPILEPSY
OR ANY OTHER SIGNIFICANT DISEASE IN PAST.
• NO H/O BLOOD TRANSFUSIONS.
• NO H/O RECENT OR PAST SURGERIES.
FAMILY HISTORY:
• NO H/O TWINNING IN THE FAMILY.
• NO H/O OF BABY BORN WITH ANOMALY IN THE FAMILY.
• NO H/O DM, HTN , ASTHMA , TB , THYROID DISEASE, EPILEPSY OR
ANY OTHER SIGNIFICANT DISORDERS IN THE FAMILY.
• NO H/O HDP- HYPERTENSIVE ORDERS OF PREGNANCY IN MOTHER OR
SISTER.
PERSONAL HISTORY:
• APPETITE IS MODERATE.
• SHE CONSUMES LOW CALORIC VEG DIET.
• SLEEP IS SOUND AND UNDISTURBED.
• BOWEL AND BLADDER HABITS ARE NORMAL AND REGULAR.
• H/O SMOKING IS PRESENT - 2 CIGARETTES/DAY.
• NO OTHER H/O DRUG ABUSE LIKE ALCOHOL CONSUMPTION ,GUTKA
OR BETEL NUT CHEWING IS PRESENT.
GEN. PHYSICAL EXAMINATION:
• 22 YRS OLD PRIMIGRAVIDA IS MODERATELY BUILT AND NOURISHED.
• SHE IS CONSCIOUS, CO OPERATIVE AND WELL ORIENTED TO TIME,
PLACE AND PERSON .
VITAL PARAMETERS:
• PULSE- 94 BPM , REGULAR
• BP- 150/100 mmHg RIGHT ARM IN SITTING POSITION.
• RESPIRATORY RATE: 16 CYCLES / MIN.
• NO PALLOR ,ICTERUS, CLUBBING , LYMPHADENOPATHY.
• B/L PITTING PEDAL EDEMA IS PRESENT.
• HEIGHT- 164 CMS
• WEIGHT - 48KGS
• BMI- 17.9 KG/m2 ( UNDER WEIGHT)
• THYROID , BREAST AND SPINE ARE NORMAL.
SYSTEMIC EXAMINATION:
• CVS- S1 S2 HEARD NORMALLY AND NO MURMURS PRESENT.
• RS- B/L CHEST CLEAR AND NO ADDED SOUNDS PRESENT .
• CNS: CONSCIOUS AND ORIENTED TO TIME , PLACE AND PERSON.
PER ABDOMEN EXAMINATION:
• CONSENT IS TAKEN. SHE IS EXAMINED IN SUPINE POSITION WIH BOTH
THE HIPS AND KNEE SEMIFLEXED AND EXPOSING FROM XIPHI
STERNUM TO PUBIC SYMPHSIS UNDER BROAD DAY LIGHT IN THE
PRESENCE OF A FEMALE ATTENDER.
• INSPECTION:
• ABDOMEN IS UNIFORMLY DISTENDED.
• FLANKS AREN'T FULL.
• UMBILICUS IS EVERTED.
• LINEA NIGRA AND STRIAE GRAVIDARUM ARE SEEN.
• NO DILATED VEINS /SCARS /SINUSES.
• PALPATION:
• UTERUS IS RELAXED.
• SYMPHYSIOFUNDAL HEIGHT IS 30CMS.
• EXPECTED FETAL WEIGHT IS 2.2 KGS .
• UTERUS CORRESPONDS TO 30 WKS OF GESTATION.
LEOPOLD GRIPS:
• FUNDAL GRIP: SOFT , IRREGULAR STRUCTURE FELT S/O BREECH.
• LATERAL GRIP:
RIGHT - IRREGULAR KNOB LIKE STRUCTURES S/O LIMBS.
LEFT - SMOOTH , CURVED, CONTINUOS RESISTANCE S/O BACK.
• 1ST PELVIC GRIP: HARD , GLOBULAR, INDEPENDENTLY BALLOTABLE
STRUCTURE S/O HEAD.
• 2ND PELVIC GRIP : CONVERGING FINGERS SUGGESTING HEAD IS NOT
ENGAGED.
AUSCULTATION:
• FETAL HEART SOUND : 140 BPM, HEARD ALONG LEFT
SPINOUMBILICAL LINE.

• PER VAGINAL EXAMINATION NOT DONE

SUMMARY:
• A 22 YRS OLD PRIMIGRAVIDA AT 37WKS OF GESTATION , ADMITTED
WITH THE COMPLAINTS OF SWELLING OVER BODY SINCE 15 DAYS,
HEADACHE SINCE 1 WEEK AND BLURRING OF VISION SINCE 1 DAY. SHE
IS PERCEIVING NORMAL FETAL MOVEMENTS. THERE IS NO H/O ANY
OTHER IMMINENT SYMPTOMS.
• ON GENERAL PHYSICAL EXAMINATION , GENERALIZED BODY
SWELLING WITH B/L PITTING PEDAL EDEMA IS PRESENT. HER BP IS
150/100 mmHg .
• HER CARDIOVASCULAR AND RESPIRATORY SYSTEMS ARE NORMAL.
• OBSTETRIC EXAMINATION REVEALS UTERUS IS UTERUS IS SMALL TO
GESTATION WITH SINGLETONLIVE FETUS IN CEPHALIC
PRESENTATION.UTERUS IS RELAXED . ON AUSCULTATION , FHR IS
140BPM ,REGULAR AND HEARD ON LEFT SPINO UMBILICAL LINE.
PROVISIONAL DIAGNOSIS:
• A 22 YRS OLD PRIMIGRAVIDA AT 37 WEEKS OF GESTATION WITH HDP
WITH INTRAUTERINE GROWTH RETARDATION WITH SINGLETON LIVE
FOETUS WITH LONGITUDINAL LIE IN CEPHALIC PRESENTATION AND
NOT IN LABOUR IS ADMITTED FOR FURTHER EVALUATION AND
MANAGEMENT .