CLINICOPATHOLOGICAL CONFERENCE

* CPC * ANEMIA IN PREGNANCYDepartment ofGYNAECOLOGY & OBSTETRICSPresented by : Abdullah Junaid Tariq 10009 Afifa Roy 10014 Farjad Naveed Ahmad 100212 HISTORYBy :Abdullah Junaid TariqPATIENTS PROFILE Name : Zohra Kashif Husbands Name : Kashif Hussain Age : 21 yrs Married for : 1 year Resident of : Fatehgarh, Sialkot Mode of Admission : Admitted through OPD Date of Admission : 8/09/15 GPA : Primigravida LMP : 25/12/14 EDD : 2/10/15PRESENTING COMPLAINTSGestational amenorrhea ---- 36 weeksShortness of breath & Lethargy ---- 2 months

HISTORY OF PRESENT ILLNESS Dates back to 36 weeks, when my patient was in her usual state of health Then she missed her periods and confirmed her pregnancy by investigations.

Two months ago, she developed breathlessness, which was aggravated on exertion e.g climbing stairs, doing the routine household work.

Breathlessness was not associated with fever, cough, wheezing, chest pain, palpitations or edema feet It was relieved by rest.

She also experienced fatigue, after performing routine activities.Systemic InquiryAlimentary system : No history of nausea, vomiting, diarrhea, constipation or abdominal pain/crampingGenitourinary system : No history of burning micturition, increased urinary urgency & frequencyCentral Nervous system : No history of vertigo, headache or convulsionsMusculoskeletal system : No history of joint, bone or muscular painTRIMESTER HISTORYShe conceived spontaneously

1st TRIMESTER : She confirmed her pregnancy by Urine Test. Nausea and vomiting were present No history of burning micturition or increased urinary frequency/urgency No per vaginal bleeding Folic acid & calcium supplements were taken 1st Antenatal Care Visit : 6/03/15 Dating scan was done at that time 2nd TRIMESTER : Fetal movements (quickening) were felt at 5 months and were normal Calcium supplements were taken Iron supplements were prescribed but she did not take those, due to poor compliance and tolerance. Nausea & vomiting settled No burning micturition or increased urinary frequency/urgency Anomaly scan was done at 20 weeks Blood pressure was normal 3rd TRIMESTER :She developed breathlessness & easy fatigabilityBlood pressure was normalCBC was done (Hb was 8 g/dl) Fetal well-being scan was doneNo history of burning micturition or increased urinary frequency/urgencyNo per vaginal bleeding MENSTRUAL HISTORY Age of Menarche : 12 years LMP : 25th December 2014 Duration of Menstrual Period : 7/28 Pattern : Regular Flow : Average / Heavy Dysmenorrhea : Present Dyspareunia : Present Vaginal Discharge : Absent Inter-Menstrual Bleeding : Absent Post-Coital Bleeding : Absent No history of Contraceptive use Pap smear was not done

PAST HISTORY No history of TB, Hepatitis B/C, DM, Asthma, Malaria, Thalassemia, Hypertension, IHD, GI diseases No previous hospitalisations or operations No history of trauma

FAMILY HISTORYNo history of Diabetes Mellitis, IHD, TB, Asthma, Hypertension, Thalassemia, Leukemia

No history of chronic diseases and gynaecological malignancies in the familyDRUG/ALLERGIC HISTORYPatient was allergic to parenteral iron.

No other drug allergies, food allergies or seasonal allergies were noted.PERSONAL HISTORY She had normal eating and sleeping habits Urinary & bowel habits were normal She had no addictions She had gained some weightSOCIOECONOMIC HISTORYPatient belongs to a middle class family

Her husband is a factory employee

She lives in a joint family system, in her own house

Basic life facilities are met with easeCLINICAL EXAMINATIONGENERAL PHYSICAL EXAMINATION A pale looking, young lady, sitting on the bed, well oriented in time, place and person, intelligently answering the questions.

VITALS :Pulse : 85/min (regular)Blood Pressure : 130/85 mmHgTemperature : 98.6FRespiratory rate : 16/minNo clubbing, koilonychia, leukonychia.Palms were paleLower conjunctiva was paleJaundice was not presentOral hygiene was normalThyroid was normalAccessible lymph nodes were not palpableNo edema feetABDOMINAL EXAMINATIONInspection : Abdomen was symmetrically protuberant, with no scar marks, visible veins or pulsations. Striae gravidarum were present

Palpation : Abdomen was soft and non tender Symphysiofundal height was 36 cm with longitudinal lie and cephalic presentation. Fetal head was 5/5th palpable There were no palpable contractions ; Liquor was adequate

Auscultation : Fetal heart rate was normal (140/min) CARDIOVASCULAR EXAMINATION : S1 + S2 + 0 No added sounds No distended neck veins

RESPIRATORY EXAMINATION : Normal vesicular breathing with no added sounds

INVESTIGATIONSBy :Afifa Roy COMPLETE BLOOD PICTURE

BLOOD GROUP & Rh FACTOR

SERUM ALT & URIC ACID

OTHER INVESTIGATIONSRandom Blood Glucose 90 mg/dl (Normal = < 140 mg/dl)HbsAg Negative Anti - HCV Negative Urine examination NormalPeripheral blood film Microcytic hypochromic anemiaDIFFERENTIAL DIAGNOSIS(Microcytic Anemia)Iron deficiency anemiaThalassemia minorSideroblastic anemiaLead poisoningAnemia of chronic diseasePROVISIONAL DIAGNOSISIron Deficiency AnemiaMANAGEMENTGENERAL TREATMENT :Bed restProper diet

SPECIFIC TREATMENT : 2 units of blood were transfused to the patientLITERATURE REVIEW(ANEMIA IN PREGNANCY)By :Farjad Naveed AhmadDEFINITIONBy WHO : Hb < 11 gm /dl (or Hematocrit