Case Report of a Dwarf Lady With 34+ Weeks Pregnancy

1. Case Report of a Dwarf Lady With 34+ Weeks Pregnancy

2. Prepared By: Dr. ZannatulFerdaus (Akhi) Intern Doctor Gynae Unit-I RMCH, Rajshahi. Brought To You By SHEMUL www.pedimedicine.com

3. Mrs. Masura, a short stature lady, 28 years, Non-diabetic, non-hypertensive, Muslim, housewife of lower class family hailing from puraton parila, bojorpur, poba, Rajshahi admitted in gynae unit-I of RMCH on 02-06-2013 with the complaints of- • Amenorrhoea for 8 months. • Physical discomfort in her daily activities for last 1 months.

4. History of present illness: According to statement of patient, she was regularly menstruating women with normal duration and average flow. Then she developed amenorrhea but she could not accurately mention her LMP. But she was on regular antenatal check-up in Gynea out patient department of RMCH.

5. Her 1st antenatal visit was done on 10.11.12 by Rs, Gynea in Gynea out patient department & diagnosed as High risk pregnancy. Thorough investigations were done on that day. USG of pregnancy profile revealed single live pregnancy of 08 weeks & EDD- on 07.07.13. she suffered from morning sickness in her 1st trimester. Her Bowel & bladder habit is normal.

6. Dietery habit is not satisfactory. Now a days she feels physical discomfort in her daily activities. As she was diagnosed as a high risk pregnancy , she was advised for hospitalization for better management.

7. History of Past Illness: She had no history of Bronchial asthma, Heart disease, Renal disease, Malabsorption syndrome, DM. Family History: Patient’s parents are alive. she has 3 brothers and 3 sisters. All are in average body built. No history of dwarfism in her maternal or paternal side.

8. Socioeconomic history: She comes from a lower class family.. Personal history: She is nonsmoker & nonalcoholic Obstetric History: • She is married for 10 years. • Para – 0+1 [1-MR] • Gravida-2nd.

9. Menstrual History • Age of menarche – At 18 years. • Menstrual cycle-Regular • Menstrual period -2-3 days. • Menstrual flow – scanty. LMP-? [Could not mention accurately] • EDD- 07.07.13 (According USG) She also gave history of delayed onset of puberty.

10. Contraceptive History: She takes OCP as a contraceptive. Drug History Become of her delayed on set of menarche, she took some herbal & Homeopath medicine for several years from local doctor. But she did not go to a registered physician. Now she takes hematinics & calcium regularly

11. General physical Examination • Appearance – Anxious • Body- Build- below average • Height-104.14cm/3-’5” • Weight – 20 kg • BMI- 17.59 • MAC-15cm • Voice-childish • Anemia-Mild • Jaundice-Absent • Oedema-absent

12. Cyanosis-Absent • Clubbing-Absent • Pulse-98b/min • BP-100/60mm of Hg • Temp-Normal • LN-Not palpable • Thyroid gland-Not enlarged • Gum, Teeth-Normal

13. Breast Examination: Breast is well developed and shows normal pregnany changes. Systemic Examination: Cardio respiratory system normal. Musculoskeletal system reveals: Low muscle bulk & bony mass. Muscle power is normal.

14. Other system reveals: No abnormality Local Examination: Per abdominal examination: Inspection: Linea nigra, stria gravidarum are present. Umbilicus is everted and centrally placed.

15. Palpation: • FH-corresponds to 34+weeks • SFH-30 cm • The girth of abdomen-75 cm • There is a single fetus with cephalic presentation. Head not engaged. Liquor volume seems to be adequate. Auscultation: FHS not audible But foetal movement present.

16. Per vaginal Examination: Restricted Investigations: Blood grouping and Rh typing- A(+ve) Hb% 9.3 mg/dl Urine R/M/E-Normal RBS-3.8 mmol/L T4-9.82µIU/ml (N=9.32-17.05 µIU/ml) TSH- 3.88 µIU/ml (N=0.27-4.2µIU/ml ) USG of pregnancy profile- on 04-06-2013 reveals-single live pregnancy of 34+weeks with cephalic presentation and estimated fetal weight-2470mg

17. Proposed Investigation: • CBC • HBsAg • VDRL • Echocardiography • MRI of Brain • Growth hormone

18. Salient Feature Mrs. Masura, dwarf lady of 28 years, 2nd gravida, para-0+1, Muslim, housewife of lower class family hailing from paraton parila, bojorpur, Poba, Rajshahi has been admitted in RMCH at her 34 weeks pregnancy. Her menstrual cycle was regular. But she could not accurately mention her LMP she had regular antenatal check-up. At her first visit in Gynae out patient department of RMCH she was diagnosed as a case of high risk pregnancy.

19. Thorough investigations were done on that day. USG revealed that single live pregnancy of 8 weeks & EDD on 07-07-2013. Patient was duely immunized. Her bowel and bladder habit is normal. All her family members are in average weight and body built she had no family history of asthma, DM, HTN. Patient had a history of delayed onset of puberty and her age of menarche was at 18 years.

20. On general examination, Height-3’-5”, wt-20kg, BMI-17.59, MAC-15cm, childish voice, mildly anaemic, oedema, cyanosis, clubbing-absent, pulse-98/min, BP-100/60mmofHg, temperature-normal, LN-not palpable, Thyroid gland-Not enlarged. Breast is well developed and shows normal pregnancy changes, on systemic examination, cardiorespiratory system normal. Musculoskeletal system revels low muscle bolt and bony mass. other systems are normal, per abdominal examination fetal movement was present. FH-corresponds to 34+ weeks.

21. SFH-30cm grith of abdomen 75cm. There was a single fetus with cephalic presentation. Head was not engaged. Liquor volume seems to be adequate. Her blood group A(+ve), Hb%-9.3 mg/dl, urine R/M/E-Normal, RBS-3.8mmol/ml. USG of pregnancy profile on 04-06-2013-Single live pregnancy of 34+weeks with cephalic presentation and estimated fetal weight-24.70mg.

22. Diagnosis: 2nd gravida with 34+weeks pregnancy of a dwarf lady (High risk pregnant lady).

23. Management: • Bed Rest • Analgestic-visceralgin • Hematinics • Calcium • Tab. Purisal • Inj. Roxadex-2doses given • Antiulcerant • Careful follow up.

24. Treatment Plan: Elective caesarean section.