1 / 12

Case Presentation

Case Presentation. Obstestrics 성균관대학교 의과대학 m5 손의영 Pt ID : 17001406 주 0 희 37/F. Chief Complain. Amenorrhea for 38 + 5 weeks w/ vaginal bleeding Onset : 2011-06-12 PM 09:00 부증상 : previous C-sec Large for Gestational Age. Obstetric History. Para : (1) - (0) - (1)(1,0) - (1)(1,0)

Download Presentation

Case Presentation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Case Presentation Obstestrics 성균관대학교 의과대학 m5 손의영 Pt ID : 17001406 주0희37/F

  2. Chief Complain • Amenorrhea for 38 + 5 weeksw/ vaginal bleeding • Onset : 2011-06-12 PM 09:00 • 부증상 : previous C-sec Large for Gestational Age

  3. Obstetric History • Para : (1) - (0) - (1)(1,0) - (1)(1,0) • 최종 월경 시작일 : 2010-09-14 • 분만예정일 : 2010-06-21

  4. Present Illness • Routine OB Lab : 특이사항 (No) • HBsAb/Ag (+/-), Rubella IgG/IgM(+/-) • Last Pap : 2008-10 특이사항(No) • Serum screening test : Quad test • 결과 (+) Down syndrome • Amniocentesis : Karyotype ( Normal) • 50g OGTT : ▲181mg/dL • 100g OGTT : ( 83 - 113 - 111 - 102 )mg/dL • CBC : 특이사항 (No)

  5. Present Illness • Vaginal bleeding 2회로 ER 내원, 경과 관찰 후 퇴원 • 2011.04.07 (PA29+2wks) • 2011.04.28 (PA32+2wks) • 2011.06.12(PA38+5wks)오버나이트 패드에 1/3 blood clot 양상으로 피비침 있어서 r/o Placenta previapartialis의심하에 본원 응급실 통하여 입원. • Speculum exam : 2x2cm sized blood clot, mild bleeding, no erosion on cervix • Labor feel / pain (-/-)

  6. Other History • PMHx. • HTN/DM/Tb/hepatitis/Allergy ( - / - / - / - / - ) • 약물력: (No) • 수술력: 2005-08-05 AIS -> Conization at SMC by F. 김태중Uterine cervix, conization: Chronic cervicitiswith squamousmetaplasia and mild glandular atypia • FHx. • 당뇨 : (+) • 고혈압 (-), 유전질환 (-) • SHx. • Marriage : 기혼 • smoking: no • alcohol: no

  7. Review of System • Obstetric symptoms • Fetal movement (Yes) • Uterine contraction (No) • Vaginal bleeding (Yes) • Watery vaginal discharge (No) • General symptoms • 임신 전 체중 : 67kg 현재 체중 : 83kg • 그 외 이상 소견 없음

  8. Physical Exam • General appearance • Not so ill looking • Mental status : Alert • Abdomen • Palpitation : Distended d/t pregnancy • Tenderness (No) • Rebound tenderness (No)

  9. Physical Exam • 산과 진찰소견 • FHR : Normal by USG • Presenting part : Cephalic • Rupture of membrane ( No) • Vaginal bleeding (Yes) : amount – 오버나이트 패드 1/3 적시는 정도 for 1hr

  10. Assessment • Pregnancy: 38 + 5 주 (2011-06-12 기준) • R/O placenta previa

  11. Plan • 진단계획 USG NST Check vaginal bleeding • 치료계획 Elective or Emergent C/sec 6/16 Time C/sec • 퇴원계획 수술 후 합병증 없을 시 PP#4 퇴원

  12. Hospital Course • 2011-06-13 (38+6 weeks) • C-sec : Emergent Low segment transverse • Baby 1 • 남아 (4.29)kg • APGAR Score : 1min 9pts, 5min 9pts • MS (0) CN (1) GA ( No) • 분만시간 : 11:18 • NR • 수술후진단명 • Placenta previamarginalis • Previous cesarean delivery • Macrosomia • s/p conization

More Related