May 31, 2012

Case report #3
Submitted to Dr Sisay Teklu
Students:
Samuel Masresha MDR 6812/02
Samuel Negash MDR 3548/02

Addis Ababa University

Tikur Anbessa Specialized Hospital
Department of Gynecology and Obstetrics

Identification:
Tikur Anbessa Hospital
182320

Hospital no -

Name:
Kassa Mebratu
Marital status: Married
Occupation: house-wife
Orthodox

Age: 34

Address: Lideta, Addis Ababa

Date of admission: 23/09/04 EC

Sex: F
Religion: Christian

Ward-A6

Chief complaint:
Leakage of liquor of 3 hrs duration & pushing down pain of 1hr duration.

HPP:
This is a 34 year old mother who is gravida VI, para II and abortion III. The LNMP was
on 2/13/03 making the EDD 7/10/04 and the gestational age 38 weeks by date. The
cycle was regular and she had not used any contraceptives.
She knew she was pregnant after she missed two consecutive menses. She went to
a health center for her first ANC on the 35 th week of gestation. She did not come for
an earlier check-up because she was afraid the cost would be unbearable. Diagnosis
of pregnancy was confirmed by ultrasound at the first ANC. General physical
examination, blood tests and urine analysis were done. She was told that she had
an elevated blood pressure but she was not told the results of the tests. She was
then referred to Tikur Anbessa Hospital because of the elevated blood pressure.
At Tikur Anbessa, general physical examination and ultrasound were done. BP was
130/90 mmHg. Lab was requested and the results were Hgb 12 g/dl. Blood group
and Rh (B+), FBS (108 mg/dl), VDRL (non-reactive), HBsAg (-ve), PICT (NR), U/A (190
mg/day protein in urine). She was given TT vaccination and iron supplement. She
was told she should have follow up every week because of the raised blood pressure
but there were no other complications.
The 2nd visit was on the 36th week of gestation. The BP was still the same. She was
told there were no new complications.
The 3rd visit was on the 37th week of gestation. The BP was still the same. There
were no new complications.
Quickening first occurred on 25/04/04. It was kicking in type. Fetal kicking
movements have not decreased during the rest of the pregnancy. She had no loss in
2

appetite. She had 5 meals per day consisting of injera, meat, vegetables and fruit.
She claims a total weight gain of about 10 kg.
Apart from the elevated blood pressure there were no significant events in the 1 st,
2nd, 3rd trimester.
Leakage of liquor occurred at 6:00 am, 2 hrs before the onset of labor. The liquor
was watery, clear and had no odor. Pushing down pain was intermittent and
progressively worsened in intensity and frequency.
She
She
She
She
She
She
She
She
She

has
has
has
has
has
has
has
has
has

a swelling on the both feet but not on legs or face

no history vaginal bleeding, discharge or fever.
no history of headache, vision disturbances,
no history of epigastric pain or yellowish discoloration of skin.
no history of abnormal body movement or loss of consciousness.
no history of decreased urine output
no history of cough, shortness of breath or bluish discoloration of skin.
no previous history of hypertension, diabetes mellitus.
no history of hypertension during previous pregnancies

The pregnancy was planned, wanted and supported. Birth was planned to
take place at Tikur Anbessa Hospital with vaginal delivery and transportation
by contract taxi. Money was prepared to cover the expenses.

Past Obstetric history

Year

1st 1987
EC
n
2
1990
d
EC
r
3
1994
d
EC
t
4
2000
h
EC
t
5
2002
h
EC

GA

place

route

outcome

wt

12
wk
Term

home

abortion

TASH

Spontaneous
vaginal
SVD

Live birth

Term

TASH

SVD

Livebirth

12
wk
13
wk

Home

Spontaneous
vaginal
Spontaneous
vaginal

Abortion

3.3
kg
3.7
kg
-

Abortion

Health
center

Ante/post
partum
complicatio
n
-

PROM
-

Gynecologic History:
The mother never took contraceptives. She has no history of sexually transmitted
diseases. She is sexually active, 1x/wk and she is monogamous. The mother has
3

had 3 abortions. They were all spontaneous and happened in the first trimester. The
last abortion was incomplete; so she went to a health center where she was
assisted by manual vacuum aspiration. She has no history of gynecologic
operations. She has no history of circumcision.

Menstrual history:
She had menarche at 12th year. Her menses were regular and spaced 4 weeks apart
except during pregnancy. The duration of flow is 4 to 5 days. She uses 2 pads per
day. The flow is dark and non-clotting. She feels mild discomfort associated with her
menstrual flow.

Past medical and Surgical history:

She had measles at a young age. The measles resolved without any treatment. She
has no history of medical disorders like DM, or hypertension before the pregnancy.
She has had no previous transfusions. She has not experienced hypersensitivity to
drugs. She has no history of infection with STD during the current pregnancy.

Family/Personal history:
She was born in Aksum and came to Addis Ababa by the age of 14. She has 4 older
brothers and they are all healthy. She had a sister who died at the age of 6 due to
an unknown illness. Her mother and father are alive and currently healthy. She is
educated upto the level of 12th grade. She has no habit of smoking or ilicit drug use.
She is an occasional drinker with 1 bottle per week. But she does not drink during
pregnancy. She is a housewife supported by her husband with a monthly income of
2000br. Her older brothers also provide unspecified financial support. She lives with
her husband and two children in a four room house. There is a separate kitchen and
toilet and clean water supply. They have no car. There is no family history of
hypertension, diabetes mellitus, tuberculosis, allergies or mental disorders. Two of
her brothers are twins.

Review of systems:
H.E.E.N.T
Head: no headache, no head injury, no dizziness
Ears: no impaired hearing or discharge, no ringing in the ears
Eyes: no discharge, no redness, no blurred vision
Nose: no discharge, no stuffy nose, no runny nose, no sneezing
Mouth: no dental caries, no bleeding gums, no artificial dentures
Throat: no sore throat, no difficulty in swallowing, no hoarseness of voice

L/G: no mass in the neck, axillae, or groins. There is breast enlargement and
tenderness associated with the pregnancy. No discharge from the nipples. No heat
or cold intolerance
Respiratory: no cough, no expectoration, no chest pain, no wheezing, no cyanosis,
no night sweats
Cardiovascular: occasional palpitations, no shortness of breath, PND or orthopnea,
no chest pain, fatigue
Gastrointestinal: one episode of nausea and vomiting in 1 st trimester, no diarrhea,
no constipation, no abdominal pain or heart burn, no change in stool color.
Genitourinary: unquantifiable increased frequency, no dysuria, no urgency, no
hesitancy, no dribbling, no reddish discoloration of urine.
Integumentary: no rash, moist skin, no discoloration, no hair changes,
hyperpigmentation on abdomen along the midline from the umbilicus downwards.
Locomotor system: no history of pain, weakness or swelling of the joints,
Central nervous system: no history of numbness, no paralysis, urine incontinence,
seizures or speech defect

Assessment:
Bad obstetric history ( 3 nonconsecutive abortions)
PIH
PROM
Term
Risk Assessment: High risk due to hypertension and previous IUFD.