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Obstetrics and Gynecologic Case Presentation

Prepared by: IMPERIAL, Annabelle R. San Beda College of Medicine. Obstetrics and Gynecologic Case Presentation. N.G. 16 year old G1P0 LMP: March 1, 2011. Chief Complaint. Vomiting. History of Present Illness. 2 DAYS prior to consult Nausea and vomiting

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Obstetrics and Gynecologic Case Presentation

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  1. Prepared by: IMPERIAL, Annabelle R. San Beda College of Medicine Obstetrics and Gynecologic Case Presentation

  2. N.G. 16 year old G1P0 LMP: March 1, 2011

  3. Chief Complaint Vomiting

  4. History of Present Illness 2 DAYS prior to consult Nausea and vomiting (+) 20 episodes of vomiting recently ingested food No medication taken No consult done

  5. History of Present Illness 1 DAY prior to consult Persistence of nausea and vomiting (+) loss of appetite (+) >20 episodes of vomiting recently ingested food and water No medication taken No consult done

  6. History of Present Illness DAY of consult Persistence of nausea and vomiting (+) loss of appetite (+) >20 episodes of vomiting recently ingested food and water Prompted patient to consult in QMMC OB-ER

  7. OBSTETRIC HISTORY G1P0 LMP: March 1, 2011 AOG : 17 weeks 5 days EDD: December 8, 2011

  8. Menstrual History Menarche: 10 years old Coitarche: 15 years old Menstrual cycle: 28-30 day cycle Duration: 3-4 days Using 3-4 pads fully soaked

  9. Past Medical History No previous hospitalization. No allergies to food and drugs. Family History No heredofamilial diseases.

  10. Social History Non smoker Non alcohol beverage drinker

  11. Review of Systems General : (-)Weight loss (42kg to 41kg), (-) Fever, (-) Chills (+) weakness (-) anorexia Cardio-Respi: (-)Chest pain, (-)Dyspnea (-) Hemoptysis (-)Cough, (-) Palpitations, (-)Edema GIT: (-)Dysphagia, (-) Heartburn, (-) Indigestion (+) Loss of appetite (-) Diarrhea (-)Constipation GUT: (-)Urgency (-)Frequency (-)Nocturia (-)Dysuria (-)Hematuria (-)Incontinence

  12. Physical Examination BP: 110/70 PR: 80 bpm RR: 16 cpm Temp: Afebrile GS: Conscious, coherent, NICRD HEENT: AS, PPC, (+) sunken eyeballs Heart: AP, normal rate and rhythm, (-) murmur Extremities: Full ROM

  13. Physical Examination Abdomen: Globular with inverted umbilicus (-)straiegravidarum (-) lineanigra (-) tenderness in all 4 quadrants FH – bet symphysis pubis and umbilicus Auscultation: normoactive bowel sound; FHT=NA Leopold’s Maneuver: NA

  14. Physical Examination External Genitalia: Adequate hair distribution, no mass or lesion in the labia, perineum and anus Clinical Pelvimetry Flat, soft uterus enlarged to 16-18 weeks size, no contraction, (-) AMT

  15. Admitting Diagnosis G1P0 PU 17w 5d AOG NIL HyperemesisGravidarum

  16. Course in the Wards • July 2, 2011 • IVF D5LR 1L x 8 • Dx : CBC with BT, U/A, Na, K, Cl • Meds: • - Metochlopromide 1 amp TIV q8 • Incorporate 1 amp Benutrex C to D5LR 1L x 8 hrs • Small frequent feedings • VS q4

  17. Course in the Wards July 3, 2011 IVF D5LR 1L x 8 Meds: - KaliumDurule tab 1 tab TID x 5 days Small frequent feedings VS q4

  18. Diagnostic Studies

  19. Diagnostic Studies

  20. Diagnostic Studies

  21. HYPEREMESIS GRAVIDARUM (HG) • 70-85% of pregnant patients experience nausea & vomiting • 2-5 % of these women experience HG • vomiting severe enough to cause weight loss, dehydration, alkalosis or hypokalemia

  22. HYPEREMESIS GRAVIDARUM (HG) RISK FACTORS • hyperthyroidism • molar pregnancy • gastrointestinal disorders • infection

  23. HYPEREMESIS GRAVIDARUM (HG) ETIOLOGY • unknown • rising levels of HCG • estrogen, progesterone, leptin, GH, prolactin , thyroxine, ACTH • Psychological component

  24. HYPEREMESIS GRAVIDARUM (HG) SIGNS & SYMPTOMS • nausea/vomiting in early pregnancy • weight loss • dehydration • weakness • subtle PE signs

  25. HYPEREMESIS GRAVIDARUM (HG)

  26. HYPEREMESIS GRAVIDARUM (HG)

  27. HYPEREMESIS GRAVIDARUM (HG) DIAGNOSIS • History/PE • CBC • Urinalysis • serum electrolytes • Ultrasound

  28. HYPEREMESIS GRAVIDARUM (HG) MANAGEMENT • GOAL: control nausea and vomiting • Antiemetic • Small frequent feedings • Adequate hydration • Ice chips • Reassurance

  29. HYPEREMESIS GRAVIDARUM (HG) MANAGEMENT • 1st line fails • Hospitalization • Dehyration • Ketosis • Electrolyte deficits • Acid base imbalance CORRECTED

  30. HYPEREMESIS GRAVIDARUM (HG) COMPLICATIONS • Dehydration • electrolyte imbalance • renal failure • Wernicke’s Encephalopathy (Thiamine deficiency) • Vitamin K deficiency : maternal coagulopathy or fetal intracranial hemorrhage

  31. HYPEREMESIS GRAVIDARUM (HG) COMPLICATIONS Mallory Weiss tears • Characterized by upper gastro-intestinal bleeding secondary to longitudinal mucosal lacerations at the gastroesophageal junction or gastric cardia.

  32. HYPEREMESIS GRAVIDARUM (HG) COMPLICATIONS • Boerhaave syndrome - characterized by upper gastrointestinal bleeding secondary to transmural perforation of the esophagus

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