JAUNDICE IN
Mrs. X, a 26-year-old homemaker from Hoskote, presents with jaundice during her 9th month of pregnancy. She also complains of itching, lower limb pain, and burning micturition. Her history includes a normal pregnancy until onset of symptoms, such as itching all over the body, cramping pain in lower limbs worsened by walking, and burning sensation during urination. No fever, rashes, abdominal pain, or abnormal vaginal bleeding reported. Menstrual history indicates regular cycles with moderate flow. Obstetric history shows she is G3P2L2, with previous normal deliveries. Further evaluation and management are required to address her current symptoms and investigate the cause of jaundice.
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Presentation Transcript
JAUNDICE IN PREGNANCY
Name: Mrs.X Age: 26yrs Address: Hoskote Education:10th Occupation: Home maker Socio economic condition: middle(modified kuppuswamy classification) Date of admission: 18/01/2018
CHIEF COMPLAINS G3P2L2 with h/o 9 months period of gestation Itching all over the body * 1month Pain in the lower limb since * 1month Burning micturition * 15days
HISTORY OF PRESENT ILLNESS G3P2L2with 9 month period of pregnancy appreciating fetal movements well was apparently normal 1month back came with complains of
Itching over the body since 1month, Seen all over the body, Through out the day Associated with scratch marks on hands and legs. No aggravating and relieving factors, No diurnal variation No h/o excessive dryness of skin
C/o pain lower limbs since 1month Insidious onset gradually progressive Cramping type of pain Aggravates on walking and relived on rest Associated with engorged veins on legs Pain non radiating
C/o burning micturition since 15days Associated with High coloured urine Increased frequency of micturition Nocturia Itching Sometimes dysuria No h/o hematuria
No H/O Fever Rashes Pain abdomen Change in stool colour and consistency Bleeding or leaking P/V
Menstrual history: Age of menarche : 13yrs 3/28 days, regular, moderate flow, no dysmenorrhea LMP - 28/04/17 EDD 05/02/18 POG 37wks 6days
Obstetric history: G3P2L2, married since 7yrs 1st pregnancy: 5 yrs back spontaneous conception had regular ANCs Full term normal delivery at hospital 2.5kg birth weight 5year old healthy No ante/intra/postnatal complications No jaundice or htn
2ndpregnancy: 2yrs ago spontaneous conception had regular ANCs FT normal delivery Girl , 2.75kgs birth weight no ante/intra/postnatal complications
Present pregnancy I Trimester Spontaneous conception UPT done at 1 months Tab Folic acid taken from 6wks POG Dating scan done No h/o hyperemesis No h/o similar complains No h/o admission No H/O drug usage or radiation exposure
II Trimester Quickening at 5th month Anomaly scan done no major anomalies Has taken 2 doses of TT Has taken iron & calcium supplements No h/s/o anemia, hypertension, UTI No abnormal discharge per vaginum No h/o similar complains
III Trimester Appreciating fetal movements well Has taken iron & calcium supplements Growth scan done said to be normal No h/s/o anemia, hypertension, UTI No abnormal discharge per vaginum Came with above complains
Past history No H/o hypertension, bronchial asthma, epilepsy, pulmonary TB , thyroid disorder, drug allergies, surgeries or blood transfusions No h/o travel, jaundice in neighborhood.
No GDM, hypertension, preeclampsia, multiple pregnancies or congenital anomalies in family Family history No h/o similar complains in the family
Personal history: Diet: mixed Appetite: good Sleep: adequate Bowel and bladder habits: normal and regular. No addictive habits
General physical examination Young lady, conscious and coherent Moderately built & moderately nourished Height-158cms Breast-normal Weight -71kgs Thyroid-normal Pre pregnancy BMI-26 Spine-normal Weight gain during pregnancy: 9 kgs Scratch marks on legs and arms present Icterus seen on bulbar conjuctiva No pallor, edema, cyanosis, clubbing, lymphadenopathy
Vital parameters: Temperature: afebrile Pulse rate -82/min ,regular rhythm ,normal volume Blood pressure-120/70mm of Hg ,right upper limb in sitting position Respiratory rate-16/min CVS- S1 S2 heard, no murmurs RS- B/L NVBS present, no adventitious sounds
Per abdomen: INSPECTION: Abdomen is uniformly distended by gravid uterus Linea nigra & striae gravidarum present Umbilicus central and flat No scar and sinuses Flanks not full
Palpation: Uterus 36 wks size, relaxed Fundal grip: broad, soft and irregular mass suggestive of breech Lateral grip: Smooth curved resistance s/o back felt on left side Irregular knob like s/o limb buds felt on right side 1st pelvic grip: cephalic and head was ballotable (5/5th palpable) 2nd pelvic grip: fingers converging- head not engaged - occiput lower to sinciput- well flexed head
SFH-35cms,EFW- 3.56kgs Abdomen girth-98cms, Auscultation: FHS+142bpm, at Left spino-umbilical line
Diagnosis 26 yrs lady G3P2L2 with 37wks 6days gestation, with single live intra uterine gestation with longitudinal lie with cephalic presentation not in labor with jaundice in pregnancy
INVESTIGATIONS: Hb% - 10.7gm% TC 4,700 , DC P76,L2O,E4 Platelet count 1.56 lakhs PCV 33 P/S normocytic normochromic Urine Alb Nil Bile salts and pigments- neg Sugar Nil Micro 2-3 pus cells, 4-5 epi cells Blood group; O +ve , Husband- O +ve HIV, HBsAg, VDRL, HCV were non reactive
RFT B.Urea:12mg/dl S.Creatinine:0.9mg/d l S.Uric Acid: 4.6mg/dl LFT Total bilirubin: 2.7 mg/dl Direct: 1.1mg/dl Indirect: 1.6 mg/dl ALT: 45 U/L AST: 47 U/L ALP: 467 U/L TP: 5.4 g/dl Albumin: 2.8 g/dl NST Reactive USG- SLIUG Of 38wks, AFI-10, EFW- 3.567g
