Case Report of a Dwarf Lady With 34+ Weeks Pregnancy

Prepared By:Dr. Zannatul Ferdaus (Akhi)

Intern Doctor

Gynae Unit-I

RMCH, Rajshahi.

Brought To You ByBrought To You By

SHEMULSHEMUL

www.pedimedicine.comwww.pedimedicine.com

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.

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.

History of present illness:

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.

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.

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.

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.

Menstrual HistoryAge 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.

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

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

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

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.

Other system reveals: No abnormality

Local Examination: Per abdominal examination: Inspection: Linea nigra, stria gravidarum are present. Umbilicus is everted and centrally placed.

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.

Per vaginal Examination: Restricted

Investigations:Blood grouping and Rh typing- A(+ve) Hb% 9.3 mg/dlUrine 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

Proposed Investigation: CBC HBsAg VDRL Echocardiography MRI of BrainGrowth hormone

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.

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.

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.

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.

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

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

Treatment Plan: Elective caesarean section.