Patients Details:

Name: ARINA BINTI MOHD ABU BAKAR

old
Address: WAKAF MEK ZAINAB
Married
Gravida: 1 Parity: 0
POA: 32 week 4 days
880203035416
LMP: 4/12/2013 EDD: 11/11/2014
DOA: 17/08/2014 10am

Age: 26 years
Marital Status:
NRIC:
RACE: MALAY

Chief Complaint
Intermittent lower abdominal pain since 0600 hours (9am) on 17th of Sepetember
HOPI
The patient is a 26 year old Malay female at 32 weeks and 4 days of her pregnancy. She is
Gravida
1 and Para 0 . She was admitted to HRPZ2 on 17th August 2014. Around 10am following lower
abdominal that pain began at 6am on the 17th September.
Pain was described as intermittent for every 5minutes. Lasting for 5 seconds on each episode, the
patient scored the pain as intolerable. Patient vomited (3-4 times). The content is only mucous.
Patient had dizziness . There has been no any discharge and then but no blood was observed.
Neither did she have any difficulty in micturition nor leaking liquor. However, patient steers
clear of any fever or chest pain and is void of any history of fall or abdominal trauma. Otherwise,
patient did not exhibit any symptoms of UTI or URTI.
Antenatal History
Antenatal booking was done on the 20th week of pregnancy. Followed up on 26th weeks.
Her records are as follows :
Height : 160cm
Weight (before) : 50kg
Weight (after) : 57kg
Blood group : B+ve
Hb : 7.5g/dL
Urine Alb. : NIL
Urine Glucose : PRESENT
VDRL/TPHA : negative
HIV Rapid Test : negative
Past Medical History
NIL
Past Surgical History
NIL

Family History
Patient have two elder brother. She is the last child of three siblings of whom all were born
through simple vaginal delivery. Patients parents are both healthy.
Social History/ Environmental History
Patient is housewife. Her husband 30year old gentleman is a police officer. His monthy income
is average.
Drug History
Neither on any medication or contraceptive pills prior to pregnancy.
Allergy History
NIL
Systemic review
CNS : None
CVS : None
Respiratory : None
GIT : None
GUT : None
MS : None
Menstrual History
Patient attained menarche at 13 years and has been regular. Her cycle is between 28-30 days and
lasts about 6-7 days. Peak flow is on the 2nd day.
Gynaecological History
No history of fibroid or any other menstrual abnormalities including dysmenorrhea.
Obstetric History
Primigravida
Physical Examination
GENERAL
Alert, conscious and cooperative. Appeared lethargic but comfortable. She was not in pain during
examintaion.
BP : 105/60
HR : 64 bpm
T : 37
Lungs : Clear
CVS : No murmurs
Head & Neck ;
- Clear white sclera with pale conjuctiva
- No preorbital edema
- Pink mucosa, tongue and good oral hygiene
- Cervical nodes impalpable

Limbs
- Warm and dry palms
- Healthy nails with good perfusion
- Pretibial edema absent and veins are normal
LOCAL
Upon inspection the abdomen was distended with presence of line nigra and no striae
gravidarum. . Surgical scars were absent. Deep and superficial palpation rendered
abdomen soft and non-tender. A gravid uterus was felt with cephalic fetal pole at pelvis.
Symphysial
fundal height measured 30cm corresponding to the period of gestation. Fetal lie recorded as
longitudinal with head not ballotable. Active fetal movement reported throughout.
VAGINAL EXAMINATION
Cervix was soft and anterior. Os measuring 3cm with membrane intact. The cervix is in vertex
position with -2 station. No moulding, caput or liquor leaks.
Summary
A 26 year old Malay female primigravida with POA of 32 weeks and 4 day, with irregular lower
abdominal pain was admitted on the 17th september 2014 for further management.
Provisional Diagnosis
Threatened preterm labour
Management
1)Bed rest and monitor the patient vital signs.
2)Monitor fetal heart rate
3)Fetal kick chart
Investigation
1)FBC
2)Bishop score
3)Vaginal swab for any infection

Discussion

Preterm labour
Preterm labour is the onset of labour between 24 and 37 weeks of pregnancy and is characterised
by regular and often painful uterine contractions. The cervix (opening to the uterus) can also start
to open.

Half of all women who experience symptoms of preterm labour will have no changes to
their cervix and the contractions usually stop without treatment.

Women at greater risk of preterm labour

While it is difficult to know who will go into preterm labour, some risk factors include:

smoking

use of illicit drugs eg. cannabis, sniffing solvents

previous preterm birth

having babies less than 18 months apart

multiple pregnancytwins, triplets etc

some infections e.g. urinary tract infection

previous surgery on your cervix

bleeding from the uterus during the pregnancy

premature rupture of membranes

abnormalities of the uterus eg. fibroids

excessive amounts of amniotic fluid

moderate to severe anaemia early in the pregnancy

abdominal surgery during pregnancy

abnormalities in the baby

Recognising preterm labour

As with any full term labour there are signs and symptoms you may experience that indicate
your labour has started.

Contractions
You may have been feeling your uterus tighten throughout your pregnancy. These are usually
Braxton Hicks contractions which are quite different to the painful contractions of labour.
Labour contractions commonly last more than 30 seconds and are regular. Labour may also
start as lower tummy pain or constant lower backache (that aching, heavy feeling that some
women get with their monthly period).
After sexual activity your uterus may be irritable and you may experience some tightenings
which quickly settle.
If you are less than 37 weeks pregnant, labour may progress more quickly than term labour.
Please telephone Mater Mothers' Hospitals Birth Suite on 07 3163 1918 or your midwife or
doctor as soon as you are aware of regular contractions.

Show
When the plug of mucus in the cervix, which has helped to seal the uterus during pregnancy,
comes away as vaginal discharge, it is called a show. A show can be an early sign of
labour, but equally it can happen weeks before labour starts. The mucus is usually stained
with old blood, and is not usually of concern. However any fresh blood loss, especially if it is
not mixed with mucus should be reported to your midwife or doctor immediately.

Rupture of membranes
The bag of amniotic fluid in which the baby is floating may break before labour starts. This
is known as ruptured membranes your waters breaking. If this happens you will notice
either a slow trickle or a sudden gush of fluid from your vagina that you cant control. If this
happens use a clean sanitary pad (not a tampon) to absorb the fluid and telephone Mater
Mothers' Hospital Birth Suite on 07 3163 1918 or your midwife or doctor. They will ask
about the amount of fluid, the colour of the fluid (straw-like or yellowish like urine), its
smell (sweet smelling or ammonia smelling), your babys movements and your pregnancy
history to date.

Management of threatened preterm labour

You will be assessed and examined by a midwife and a doctor and this will include:
monitoring of your babys heart beat with a cardioticigraph (CTG) machine
A speculum examination to see whether your cervix is opening and/or if your waters
have broken
Observations of your contractions
There are tests which can help identify whether preterm birth is likely and may include a
swab from the vagina or a scan.

Possible treatment

As preterm labour can progress more quickly than term labour if you are considered to be at
risk of preterm birth, you will be admitted to hospital for continued observation and
management.
If you are between 24 and 34 weeks pregnant you will be offered two steroid injections 12
hours apart. Steroids are given to improve lung maturity in premature babies and take about
24-hours to be effective. This is to reduce breathing difficulties after birth.
You may be given some tablets (nifedipine) to help slow or stop labour. This is a smooth
muscle relaxant and therefore helps to stop the muscles of the uterus contracting.
Women who are less than 30 weeks and at risk of preterm birth may be offered treatment of
magnesium sulphate. This given intravenously over 24 hoursimproves the chances of
your baby surviving and reduces the risk of neonatal complications.

If your labour continues

If your labour cannot be stopped your baby may be born early. If your baby is presenting
head first and there are no other concerning factors a vaginal birth is likely. However, a
ceasarean birth may be recommended in a variety of situations if this is thought to reduce the
risk to you or your baby. It is likely that your baby will need to be cared for in the Neonatal
Critical Care Unit at Mater Mothers' Hospitals.
Whenever possible a specialist neonatal doctor will come and talk to you before the birth of
your baby. They will discuss the care that your baby will need and the chances of your baby
having any long term complications.

If your labour stops

If your condition stabilises and you go home, you may be advised to avoid sex until your
baby is born. Please discuss this with your midwife or doctor.

CASE WRITE UP
LINCOLN UNIVERSITY
COLLEGE
2

nd

case write up

NAME: LOGESWARAN
BALAKRISHNAN
STUDENT ID: LUCMEDDEC1117