My obs case write up

Madam K 42 years old Malay lady G9P3+5 currently at 38 week POA. Known case GDM on insulin therapy admitted for induction of labour.

Currently she had no contraction pain, show, or leaking liquor. Good fetal movement. No symptom of hyperglyceamia. no symptom hypoglyceamia. No UTI

Antenatally
Last normal menstrual period 7th march 2009 and expected delivery date was 14th disember 2009
This is a wanted and planned pregnancy. She knew she was pregnant when she missed her menses at 6 week period of amenorrhea. urine pregnancy test was done at private clinic and it was positive. Booking was done at PPUKM at 8 weeks period of amenorrhea. Dating scan was done at 8 weeks POA and clinical parameter correspond to date.

Antenatal screening was done at 13 weeks POA.
Height: 155cm,
weight: 74kg, currently 86kg, increment of 12kg.
BMI: 30.8
BP: normotensive.
Booking hb: 11.1,
Urine albumin/sugar: nil
Blood group: O+
In view of obesity and advanced maternal age MGTT was done at 21 week POA. 5.8/9.9.
She was admitted at 23 weeks POA for 4 days for insulin commencement.
BSP was done 6.7/6.6/5.1/9.7
Insulin therapy was started
Currently she was on actrapid 6u/6u/6u and insulatard 8 on
Home self monitoring of sugar ranges 4.3-7.2

At 13 weeks POA ultrasound scan of the fetus revealed increased in nuchal translucency.
Serial scan was done and a total of 11 scan was done during the pregnancy. No abnormality was detected. Detail scan was done at 17 weeks POA and it was normal.
Latest scan was done at 36 week 5 days. Presence of fetal heart and fetal movement, all growth parameter correspond to date. Placenta at anterior upper segment. AFI:16.8. EFW: 3192g

Patient delivered 3 children at full term via spontaneous vertex delivery between 1987 to 1998. The birth weight ranges from 2kg to 3kg. however her first child developed cerebral palsy at 4 months old due to meningitis and currently alive. Her 2 other children were alive and well. Her last child was from her second marriage.

She had 3 termination of pregnancy between 1988 to 2008 because of family burden? All of them done at 8 weeks of POA and elective dilatation and curettage was done. No complication was noted.

In june of 2009, she presented with acute abdominal pain and per vaginal bleeding at 5 week period of amenorrhea. She was diagnosed ectopic pregnancy and right salphingectomy was done at PPUKM.

In December 2009, she presented with per vaginal bleeding and passing of complete product of conception at 12 weeks POA. No D+C was done and no complication noted.

She attained menarche at 13 years old. She had menstrual flow for 7 days duration with menstrual cycle of 28 days. She uses 3 pads fully soaked per day during menses. She had dysmenorrheal but not taking medication. No menorrhagia, intermenstrual bleed, or post coital bleeding. She had Pap smear done last june 2009 and the result was normal. She never uses contraception

No significant past medical history. She allergic to penglobe and metformin.

Her parents died due to old age. She is the youngest from 7 siblings. No family history of diabetes and hypertension.

Her 1st marriage from 1986 to 1991. Her 2nd marriage from 1995 till now. Currently work at human resource department in Besraya Tol company. She does not consume alcohol and she does not smoke. Her family size is 4 children. Spacing for the next pregnancy is 2 years.