ADCON Oct 9-10
ADCON Oct 9-10
ADCON Oct 9-10
October 9 - 10
DRs MACASPAC/ RONQUILLO-SARMIENTO
PGIs SHRESTHA/ VITUG
OB-CASES
GYNE-CASES
(i) Service
1 (pathologic)
(ii) Private
2 (non-pathologic)
(i) Service
(ii) Private
1 (pathologic)
RESOLVED:
UNRESOLVED:
Total: 6
Ward Census
FLOOR
OLD
NEW
REFERRAL
TOTAL
3RD MB
3RD MT
5TH MB
5TH MT
8Th MT
ICU
TOTAL
10
Patient Profile # 1
MB, 33
G2P1
(1001)
Filipino
Guagua
(+) BP of 184/130
(+) Headache
(-) Nausea/ Vomiting
(-) vaginal bleeding
(-) hypogastric pain
Consult
PAST
MEDICAL
(+) HPN x 15 yr
Aldomet
(-) DM
(+) Asthma
Last attack- 2yr ago
Asthmalin
(-) Allergy
(-) Goiter
(-) hepatitis
FAMILY HX
P AND S HX
(-) Smoker
(-) Alcoholic bev.
Drinker
Catholic
college graduate
unemployed
Married
Obstetrics History
G2P1 (1001)
G1 : 2006, FTBB, CSI x Preeclampsia,
Gynecologic History
M=13 Y/O
I= Irregular, 3-6 mo
D= 5 DAYS
A= 5 PPD/FULLY SOAKED
S=(-) DYSMENORRHEA
1st SC:
#SP:
(+) OCP use 1 YEAR (2009)
(-) Post-Coital Bleeding
(-) Dyspareunia
(-) Pap Smear
PHYSICAL EXAMINATION
General: awake, conscious, coherent, not in
cardio-respiratory distress
Vital signs:
BP: 170/120 PR: 87 RR: 19 Temp: 36oC
Height: 55
Previous Weight: 51 kg, BMI= 18.7 kg/m2
Current Weight: 60 kg, BMI= 22 kg/m2
Wt. gain: 9 kg
PHYSICAL EXAMINATION
HEENT: pink palpebral conjunctivae,
anicteric sclerae
PHYSICAL EXAMINATION
Abdomen:
Leopolds maneuver:
LM1: large, nodular mass occupies the fundus (breech)
LM2: hard resistant structure on the right maternal side, irregular mobile parts on the
left maternal side
LM3: hard, round non-ballotable structure (cephalic, engaged)
LM4: head descent, cephalic prominence on the opposite side of the fetal back
IE: Cervix closed
Extremities: full and equal pulses, (-) edema
Initial CTG
B FHT: 150-155s, moderate variability, (+) accelerations, (-) decelerations, UC: none
Admitting diagnosis
G2P1 (1001) PU 29 6/7 weeks AOG,
Not in labor
Chronic hypertension with
superimposed severe preeclampsia
PLAN
MgSO4 5g deep IM on each buttocks
Hydralazine 5mg/IV
Dexamethasone 6mg/IM
MgSO4 drip MgSO4 10g in PNSS 500cc x 100cc/hr
Patient Profile # 2
MG, 31
G2P1
(1001)
Filipino
Mabalacat
PAST
MEDICAL
(-) HPN
(-) DM
(-) Asthma
(-) Allergy
(-) Goiter
(-) hepatitis
FAMILY HX
P AND S HX
(-) Smoker
(-) Alcoholic bev.
Drinker
Married
Catholic
College graduate
Ophtha Nurse
Obstetrics History
G2P1 (1001)
G1 2012, FTBG, NSD, lying-in clinic,
Gynecologic History
M=13 Y/O
I= Regular, 30 day cycle
D= 4 DAYS
A= 4-5 PPD/MODERATELY SOAKED
S=(-) DYSMENORRHEA
1st SC: 20
#SP: 1
(-) OCP use
(-) Post-Coital Bleeding
(-) Dyspareunia
(-) Pap Smear
PHYSICAL EXAMINATION
General: awake, conscious, coherent, not in
cardio-respiratory distress
Vital signs:
BP: 130/80 PR: 84 RR: 18 Temp: 36.6oC
Height: 55
Previous Weight: 134 lbs, BMI= 22.4 kg/m2
Previous Weight: 160 lbs, BMI= 26.7 kg/m2
Wt. gain: 26 lbs
PHYSICAL EXAMINATION
HEENT: pink palpebral conjunctivae,
anicteric sclerae
PHYSICAL EXAMINATION
Abdomen:
Leopolds maneuver:
LM1: large, nodular mass occupies the fundus (breech)
LM2: hard resistant structure on the right maternal side, irregular mobile parts on the left
maternal side
LM3: hard, round non-ballotable structure (cephalic, engaged)
LM4: head descent, cephalic prominence on the opposite side of the fetal back
IE: Cervix 3 cm dilated (2), posterior position (0), 60 % effaced (2), med. soft (1), cephalic,
(+) BOW, Station -3 (0)
Bishop score: 5
Initial CTG
B FHT: 150-155, Moderate variability, (+) accelerations, (-) decelerations, UC: moderate
contractions every 2-3 minutes in a 20 min. strip, Montevideo units: 360
Labor Curve
HNBB 1 amp
D5LRS IL
30gtts/min
-5
HNBB 1 amp
Epidural
anesthesia
Nubain 5mg +
Promethazine
25mg/IV
Nubain 5mg +
Promethazine
25mg/IV
10
-4
-3
-2
8
7
-1
+1
+2
+3
+4
+5
0
0
10
9pm
10
11
12
1am
11
Admitting diagnosis
G2P1 (1001) Pregnancy Uterine 38
PLAN
Awaits delivery
G2P0
(0010)
Filipino
Angeles
city
PAST
MEDICAL
(-) HPN
(-) DM
(+) Asthma
Last attack : HS
(+) Allergy: Cefalexin
(-) Goiter
(-) hepatitis
FAMILY HX
(+) DM- paternal
(-) HTN
(-) ASTHMA
(+) CA- breast Camaternal
(-) heart disease
P AND S HX
(-) Smoker
(-) Alcoholic bev.
Drinker
Catholic
Vocational graduate
Cashier
Married 6 mo
Obstetrics History
G2P0
G1 : 2008, 1 mo, complete miscarriage
G2: PP
LMP: 01/03/2014
EDC: 10/10/2014
Gynecologic History
M=13 Y/O
I= Regular, 28 day cycle
D= 3-4 DAYS
A= 4-5 PPD/MODERATELY SOAKED
S=(+) DYSMENORRHEA
1st SC: 17
#SP: 4
(-) OCP use
(-) Post-Coital Bleeding
(-) Dyspareunia
(-) Pap Smear
PHYSICAL EXAMINATION
General: awake, conscious, coherent, not in
cardio-respiratory distress
Vital signs:
BP: 120/80 PR: 88 RR: 19 Temp: 36.6oC
Height: 54
Previous Weight: 52 kg, BMI= 19.7 kg/m2
Current Weight: 65 kg, BMI= 24.6 kg/m2
Wt. gain: 13 kg
PHYSICAL EXAMINATION
HEENT: pink palpebral conjunctivae,
anicteric sclerae
PHYSICAL EXAMINATION
Abdomen:
Leopolds maneuver:
LM1: large, nodular mass occupies the fundus (breech)
LM2: hard resistant structure on the right maternal side, irregular mobile parts on the
left maternal side
LM3: hard, round non-ballotable structure (cephalic, engaged)
LM4: head descent, cephalic prominence on the opposite side of the fetal back
IE: Cervix 3 cm dilated (2), posterior position (0), 50 % effaced (1), soft (2), cephalic,
(-) BOW, Station -2 (1)
Bishop score: 6
Initial CTG
D5LRS IL + 10 u
Oxytocin 10
gtts/min
-5
10
-4
-3
-2
8
7
-1
+1
+2
+3
+4
+5
9
0
pm
10
11
12
1 amp HNBB
1 amp HNBB
Admitting diagnosis
G2P0 (0010) PU 39 6/7 weeks AOG,
PLAN
Awaits delivery
Final Diagnosis
G2P0 (0010) PU term cephalic delivered via NSVD
Patient Profile # 4
IT, 27
G1P0
Filipino
Angeles
city
PAST
MEDICAL
(-) HPN
(-) DM
(-) Asthma
(-) Allergy
(-) Goiter
(-) hepatitis
FAMILY HX
P AND S HX
(-) Smoker
(-) Alcoholic bev.
Drinker
Born again
Vocational graduate
Technician
Married
Obstetrics History
G1P0
G1 : Present Pregnancy
LMP 1/7/14
EDC 10/14/14
AOG 39 2/7
Gynecologic History
M=12 Y/O
I= Regular, 28 day cycle
D= 4-5 DAYS
A= 4-5 PPD/MODERATELY SOAKED
S=(-) DYSMENORRHEA
1st SC: 26
#SP: 1
(-) OCP use
(-) Post-Coital Bleeding
(-) Dyspareunia
(-) Pap Smear
PHYSICAL EXAMINATION
General: awake, conscious, coherent, not in
cardio-respiratory distress
Vital signs:
BP: 120/80 PR: 88 RR: 19 Temp: 36.6oC
Height: 54
Previous Weight: 132 lbs, BMI= 22.7 kg/m2
Current Weight: 157 lbs, BMI= 26.9 kg/m2
Wt. gain: 25 lbs
PHYSICAL EXAMINATION
HEENT: pink palpebral conjunctivae,
anicteric sclerae
PHYSICAL EXAMINATION
Abdomen:
Leopolds maneuver:
LM1: large, nodular mass occupies the fundus (breech)
LM2: hard resistant structure on the right maternal side, irregular mobile parts on the
left maternal side
LM3: hard, round non-ballotable structure (cephalic, engaged)
LM4: head descent, cephalic prominence on the opposite side of the fetal back
IE: Cervix 3 cm dilated (2), posterior position (0), 50 % effaced (1), soft (2), cephalic,
(+) BOW, Station -2 (1)
Bishop score: 6
Initial CTG
B FHT: 130-135s, Moderate variability, (+) accelerations, (-) decelerations, UC: moderate
contractions every 4-5 minutes in a 20 min. strip, Montevideo units: 200
Nubain 5mg +
Promethazine
25mg/IV
D5LRS IL + 10 u
Oxytocin 10
gtts/min
-5
10
-4
-3
-2
8
7
-1
+1
+2
+3
+4
+5
12pm 1
0
2
1 amp HNBB
6
1 amp HNBB
Admitting diagnosis
G1P0 PU 39 2/7 weeks AOG,
Cephalic, in labor
PLAN
Awaits delivery
Final Diagnosis
G1P1 (1001) PU Term cephalic delivered via
Patient Profile # 3
KA, 22
G1P0
(0010)
Filipino
Catholic
Mabalacat
5 weeks
PTA
2 weeks
PTA
Persistence of vaginal
bleeding
Consult at another PMD
Advised admission
PAST
MEDICAL
(-) HPN
(-) DM
(-) Asthma
(-) Allergy
(-) Goiter
FAMILY HX
(-) DM
(-) HTN
(-) PTB
(-) ASTHMA
(-) Breast
P AND S HX
(-) Smoker
(-) Alcoholic
bev. drinker
Single
INC
Highschool
undergraduate
Unemployed
Obstetrics History
G1P0 (0010)
G1 2014, 4 months AOG, evacuated by D&C, Private
hospital
Gynecologic History
M=13 Y/O
I= Regular, 30 days cycle
D= 3-4 DAYS
A= 8 PPD/MODERATELY SOAKED
S= (-) DYSMENORRHEA
1st Sexual Contact: 17
Number of Sexual partners: 3
(-) OCP
(-) Post-Coital Bleeding
(-) Dyspareunia
(-) Pap Smear
PHYSICAL EXAMINATION
General: awake, conscious, coherent, not in
cardio-respiratory distress
Vital signs:
BP: 110/70 PR: 72 RR: 18 Temp: 36.3
Height: 5
Current weight: 39kg
BMI 17 kg/m2 (Underweight)
PHYSICAL EXAMINATION
HEENT: pink palpebral conjunctivae, anicteric
sclerae
Abdomen:
PHYSICAL EXAMINATION
Abdomen:
Admitting diagnosis
G1P0 (0010) Abnormal Uterine Bleeding
s/p D&C September 4, 2014
Plan
IVF: D5LRS 1L x KVO
For CBC, Blood typing
Tranexamic acid 1g/IV
Patient Profile # 4
PA, 31
Catholic
G3P2
(2012)
Angeles
City
Filipino
2 weeks
PTA
1 day
PTA
PAST
MEDICAL
(-) HPN
(-) DM
(-) Asthma
(-) Allergy
(-) Goiter
FAMILY HX
(-) DM
(-) HTN
(-) PTB
(-) ASTHMA
(-) Breast
P AND S HX
(-) Smoker
(+) Occ.
alcoholic bev.
drinker
Single
Catholic
College
graduate
Call center
agent
Obstetrics History
G3P2 (2012)
G1 2004, 3 months AOG, evacuated by D&C, Private
hospital
G2 2004, FTBB, CS I x fetal distress, Private hospital,
6.6 lbs, (-) complications, alive
G3 2008, FTBG, CS II x repeat, Private hospital, 4.6 lbs,
(-) complications, alive
Gynecologic History
M=13 Y/O
I= Irregular, 28 days - 3 months
D= 3-4 DAYS
A= 3 PPD/FULLY SOAKED
S= (-) DYSMENORRHEA
1st Sexual Contact: 18
Number of Sexual partners: 1
(-) OCP
(-) Post-Coital Bleeding
(-) Dyspareunia
(+) Pap Smear 2008, normal
PHYSICAL EXAMINATION
General: awake, conscious, coherent, not in
cardio-respiratory distress
Vital signs:
BP: 130/90 PR: 84 RR: 19 Temp: 36.3
Height: 55
Current weight: 162 lbs
BMI 36.9 kg/m2
PHYSICAL EXAMINATION
HEENT: pink palpebral conjunctivae, anicteric
sclerae
Abdomen:
Admitting diagnosis
G3P2 (2012) Abnormal Uterine Bleeding T/C
Endometrial Pathology
Plan
Dilatation and Curettage
Thank you