CASSETTE-CLINICS

OF
OBSTETRICS & GYNAECOLOGY

A SET OF
9 CASE PRESENTATIONS (MP3 CD)
AND A BOOKLET

BY
DR. MRS. SWATI VAIDYA
MBBS, MD (GYN)

A PART OF THE “CASSETTE-CLINICS” SERIES BY DR. GHANASHYAM VAIDYA



PUBLISHED BY :

BHALANI MEDICAL BOOK HOUSE

11, MAVAWALA BUILDING
OPP KEM HOSPITAL
PAREL, MUMBAI, 400 012
 INTRODUCTION

I feel very happy to present the Obstetrics and Gynaecology set of Cassette-Clinics to the
students of 3rd M.B.B.S. and M.D. or D.G.O.

Whether you are an undergraduate or a postgraduate, the case presentation remains

essentially the same, and the success in examinations largely depends on the impression
created during case presentation.

‘Presenting a case’ is an art, which every student must master and Cassette-Clinics is the
easiest way of learning it.

Vivas are short and it is not possible to go into the depth of the subject within the few
available minutes. So the examiner may test your knowledge in various directions to find
out what you don't know. Also, the discussion need not remain confined to the case under
study, eg. In a case of Twins, if you fumble during General Examination, examiner may
interrupt you and ask details of anemia! So you must be well prepared for an uninterrupted
presentation, as well as for the unexpected interruption.

I hope that these clinics will be very helpful to the students suffering from the syndrome of
"I know it but I can't say it" and to the students who are in search of better and perfect
answers.

These should also interest the rural practitioners, who are often expected to conduct
antenatal checkups and deliveries.

I sincerely thank all my Professors and Teachers of Government Medical College, Miraj
who have enriched me with this knowledge, particularly Dr. S.T. Watve, Dr. S.P. Dani, Dr.
Mrs. A.J. Jadhav and Dr. Mrs. P.R. Naphade.

I also thank my father-in-law Dr. M.K. Vaidya and my mother-in-law Late Mrs. V.M.
Vaidya, whose constant encouragement has helped me to complete my studies for M.D.
and prepare these cassettes. And of course, I must thank my husband, Dr. Ghanashyam,
the pioneer of Cassette-Clinics in India, who has infused this idea into my mind and
guided me all along.

Dr. Mrs. Swati G. Vaidya

Cassette-Clinics of Dr Ghanashyam Vaidya 2

 OBSTETRICS CASE PRESENTATIONS

CASE NO. 1

NORMAL ANTENATAL CASE

The examination of an Obstetric case involves the detailed examination of the pregnant woman
with relevant systemic examination depending on the symptoms.

So the history and examination consists of two parts -

1. Obstetrics Part : which is standard for all cases.

2. Medical Part : which will depend upon the complications present during the pregnancy.

1. The Introduction :

In addition to the standard contents i.e. age, name, occupation, financial status and address of the
patient, you should also state the present obstetric status of the patient as number of Gravida and
period of amenorrhoea.

Eg. 25 years old second Gravida, Padma Patil, a housewife from Sangli, from low socio-economic
class, comes with 8 ½ months amenorrhoea for antenatal check up.

2. Complaints:

Now state the complaints of the patient in chronological order, followed by history of relevant
symptoms. Ask for the expected symptoms of pregnancy like morning sickness in 1st trimester,
quickening after 20 weeks, or edema in third trimester. A pregnant patient may also come without
any complaint – for a routine Antenatal checkup.

3. Menstrual History:

1. Age of Menarche.

2. Description of previous Menstrual Cycles.

3. Date of L.M.P.

4. E.D.D. as calculated by Naegle's Rule.

eg. Menarche at 13 years of age.

Menstrual cycles regular, 4 days every 28 days, with moderate, mildly painful flow.
L.M.P. was on 3rd April, 2009.
So the expected date of delivery is on 10th January, 2010.

Cassette-Clinics of Dr Ghanashyam Vaidya 3

4. Obstetric History :

First mention the period of married life. Then state the present obstetrical status by GPLA formula.

Followed by short description of each pregnancy, labour and its outcome, particularly
complications like PIH and interference like forceps.

If there was a Caesarian Section, ask the details of indication for Caesarian – Elective or
Emergency, Lower Segment or Upper segment, and postoperative infection.

Also ask history of any other operation in lower abdomen or perineum.

eg. Married 6 years back. She is Gravida 3, Para 2, Living children 2, No abortion i.e. G3 P2 L2
A0.

Gravida 1 was a full term normal delivery in hospital, 4½ years, old live female child. No history
of antenatal intrapartum and postpartum complications. She had received 2 doses of Tetanus
Toxoid.

Gravida 2 was a full term normal delivery at home, not conducted by medical Practitioner.

5. Past History :

Ask history of Diabetes, Hypertension, Rheumatic fever, Heart disease and any other major
medical illness.

6. Family History :

Ask History of Hypertension, Diabetes and any other major illness.

And History of inheritable pregnancy related conditions like - Eclampsia, PIH & Twins,

7. Personal History :

Ask about sleep, appetite, bladder and bowel habits, and addictions to smoking or drinking. Ask
also about the mental state and problems in family life.

The General Examination :

The General Examination in an obstetric case should always start with height and weight of the
patient. Special stress should be given on 4 points - Pulse, Blood Pressure (in 15° lateral tilt if
pregnancy is beyond 28 weeks), Pallor and Edema.

If B.P. is on higher side or PIH is suspected, calculate Mean Arterial Pressure and perform roll over
test.

Examine the breasts for normal changes in pregnancy like engorgement, striae, deeply pigmented
primary areolae, secondary areolae and Montgomery's tubercles.

A routine examination of the respiratory and cardiovascular systems should be carried out, with
detailed examination if there is a suggestion of any abnormality from history or examination.

Cassette-Clinics of Dr Ghanashyam Vaidya 4

eg. On General Examination,
The patient is averagely built and nourished.
Height is 152 cms, weight is 62 kgs.
Pulse is 80/min, regular, good volume,
B.P. is 110/70 mm of Mercury in right upper extremity with patient in 15° left lateral tilt.

No pallor, minimal pitting edema over the ankles, No cyanosis, clubbing or lymphadenopathy.

Breasts are engorged, with deeply pigmented primary and secondary areolae, and Montgomery's
tubercles.
Nipples are normal, no cracks.

On Systemic Examination,
R.S. is normal, no extra sounds.
Heart sounds are normal, no murmur.

Per Abdominal Examination :

On Inspection,

Note the contour of the abdomen.

Look for Linea Nigra and Striae Gravidarum.

Measurements :

1. Palpate the height of the uterus and note whether it corresponds to the period of amenorrhoea or
not.

2. Measure the height of uterus from the upper border of symphysis pubis in cms. and calculate the
estimated fetal age and weight by McDonald's formula.

3. Measure the abdominal girth at umbilicus.

eg. On inspection, the abdomen is uniformly distended. Linea Nigra and Striae Gravidarum are
seen.
Measurements: Fundal height corresponds to 32 weeks.
The height of uterus from symphysis pubis is 28 cms.
So, by McDonald's formula the gestational age is 32 weeks,
and estimated fetal weight is 2480 gms.
Abdominal girth is 60 cms.

On Palpation,

Carry out the four standard grips.

Note the site of firm, non-ballotable breech, curved hard back,

Knob-like limbs, and hard, round ballotable head.

If the presentation is vertex, and pregnancy is in third trimester -

Cassette-Clinics of Dr Ghanashyam Vaidya 5

 (a) See whether the head is engaged or not.
(b) Compare the level of occiput and sinciput, to note the flexion of the fetal head.
(c) And perform head fitting test, if the pregnancy is beyond 36 weeks.

At this stage, you should be knowing the lie, presentation and position of the fetus.

eg. On palpation, by fundal grip, irregular, non-ballotable breech is felt.

On lateral grips, curved hard back is felt on the left side, and knob like limbs on right side.
On Pawlik's grip hard, round, ballotable head is felt.
On 2nd pelvic grip, the head is floating and occiput is lower than the sinciput.

On Ausculation,

Palpate the anterior shoulder and auscultate for the fetal heart sounds. Note the site where they are
best heard, the rate and whether they are regular or irregular.

Eg. FHS are 140/min., regular and best heard midway between umbilicus and left ASIS.

DIAGNOSIS:

3rd Gravida, - with 32 weeks pregnancy, with longitudinal lie, Cephalic presentation, - in left
occipito-anterior position - with - (complications if any).

Cassette-Clinics of Dr Ghanashyam Vaidya 6

CASE NO. 2

PREGNANCY INDUCED HYPERTENSION

This is the second case presentation, in the series of Cassette-Clinics in Obstetrics and
Gynaecology, prepared by Dr. Mrs. Swati Vaidya of The Karnatak Health Institute, Ghataprabha.

19 yrs old primigravida, ... Renuka Wader, ... from Kadegaon, ... Labourer by occupation. and from
low socio-economic class, ...

came with H/O 8 months amenorrhoea

and complains of swelling over the legs since 8 days.

There is no H/O Headache, vomiting, visual disturbances or epigastric pain.

There is no H/O Convulsions.

There is no H/O Loss of fetal movements.

There is no H/O Breathlessness, palpitations or chest pain.

No H/O Urinary complaints.

No H/O Edema prior to pregnancy.

Menstrual History: Regular menstruations with 3-4 days flow, every 30 days.

LMP: Exact date of Last menstrual period is not known. But last menses were 4 days before
Ganapati festival, which was in September this year, so Expected date of delivery will be in the
month of May.

Obstetric History: Married 11/2 yrs back .... G1 P0 L0 A0

Past History : No H/O Hypertension, Diabetes, Kidney disease or any major illness in the past.

Family History: No H/O Diabetes, Hypertension or any major illnesses in the family.
No History suggestive of Pregnancy induced Hypertension, Eclampsia or Twins in mother or sister.

She has received 2 doses of Tetanus Toxoid previously.

On General Examination,

The patient is averagely built, and averagely nourished, conscious and co-operative.
Height is 150 cms, ... weight is 52 kg.

Cassette-Clinics of Dr Ghanashyam Vaidya 7

Pulse is 90/min, good volume,

Blood pressure is 140/90 mm of Hg in right arm in left lateral position.

Patient's Mean Arterial Pressure is 106 mm.

Roll over test is positive.

Patient has mild pallor, and bilateral pitting edema of legs and hands.

Respiratory and Cardio-vascular systems are normal.

CNS :- Deep tendon jerks are normal.

Per abdomen,

Fundal height corresponds to 32 weeks .... Height of uterus is 26 cms. So the estimated fetal weight
is 2120 gms.

Breech is felt at the fundus, Back on the left side, and knob-like limbs on the right side.
On pelvic grip, hard, round, ballotable head is felt.

So it is a longitudinal lie, with cephalic presentation, with left occipito-anterior position.

On Auscultation,
FHS are 140/ min, regular, best heard midway between umbilicus and left ASIS.

My Diagnosis is,

Primigravida, with 32 weeks pregnancy, with longitudinal lie, Cephalic presentation and left
occipito-anterior position, with Hypertension, probably Pregnancy Induced Hypertension.

Cassette-Clinics of Dr Ghanashyam Vaidya 8

CASE NO. 03

PREGNANCY WITH HEART DISEASE

This is the third case presentation, in the series of Cassette- Clinics in Obstetrics and Gynaecology,
prepared by Dr. Mrs. Swati Vaidya.

19 yrs old primigravida, Shahanaz Mulani, from Bijapur, .. housewife by occupation, ... comes with
history of - 5 1/2 mths amenorrhoea.

She complains of - Breathlessness and palpitations since 2 months, and edema over the legs since 1
month.

The patient was apparently alright, 2 months back, when she started experiencing breathlessness
and palpitations. The breathlessness has gradually increased and at present she gets breathless while
doing household work, ie. Dyspnoea Grade II.

There is no H/O Fever, Cough, Expectoration, or Chest pain.

There is edema over the legs since 1 month.

Menstrual History : Menarche 5 yrs back.

Menstrual cycles are regular, 3-4 days every 28 days, with moderate flow.

LMP is 3rd July 2009, ... Expected date of delivery is 10th April 2010.

Obstetric History: Married 1 yr. back. G1 P0 L0 A0

G1 is the present pregnancy. This is the first antenatal check up.

Past History: No H/O similar illness in the past.

There is H/O swelling and pain in knee joints 4 yrs back, but has not received any specific
treatment or monthly injections.

There is H/O Repeated respiratory tract infections treated symptomatically.

No H/O Breathlessness or cardiac symptoms in the childhood.
No H/O Jaundice.

NO H/O Urinary complaints.

No H/O Headache, Vomiting, or Blurring of vision.

Family History: No H/O Eclampsia, PIH, Hypertension or any other major illness in the family.

Personal History :
Sleep is disturbed due to breathlessness.

Cassette-Clinics of Dr Ghanashyam Vaidya 9

Bowel and bladder habits are normal.

On General Examination,

Height is 150 cms ..... Weight is 48 Kg.

Averagely built and poorly nourished.
Pulse is 90 / min, regular, good volume, equal on both sides, and all peripheral pulses are well felt.
Blood Pressure is 110/70 mm of Hg, in right upper arm.
There is mild pallor and bilateral pitting edema.
Jugular Venous pressure is 5 cms .... Hepato-jugular reflex is absent.
Respiratory system is normal, no adventitious sounds.

On Examination of the Cardio-vascular system,

The apex beat is in left 5th inter-costal space, in mid-clavicular line and of tapping character.

There is no clinically detectible cardiomegaly.

There is a loud first heart sound, with low-pitched, rumbling, mid-diastolic murmur, with pre-
systolic accentuation.

Per abdomen,

Linea Nigra and Striae Gravidarum are seen.

Uterine height corresponds to 22 weeks and height measured from symphysis pubis is 19 cms.
External ballotment is present.

My diagnosis is Primigravida - with 22 weeks pregnancy, with Mitral stenosis grade III, probably
of rheumatic origin.

Cassette-Clinics of Dr Ghanashyam Vaidya 10

CASE NO. 04

PREGNANCY WITH ANEMIA

This is the Fourth case presentation, in the series of Cassette- Clinics in Obstetrics and
Gynaecology, prepared by Dr. Mrs. Swati Vaidya.

25 yrs old 3rd gravida, .. Renuka Patil, .. from Kolhapur, .. Housewife by occupation, .. comes with
History of 5 months amenorrhoea for antenatal checkup.

She complains of Breathlessness on exertion, and weakness since 2 months.

No H/O Edema
No H/O Palpitations, Cough, or Chest pain.
No H/O Fever,
No H/O Menorrhagia, Polymenorrhoea, or Post-partum bleeding in the previous pregnancies.
No H/O Worm infestations, or Per Rectal bleeding.
No History suggestive of Malaria or Jaundice.

Menstrual History:
Menarche at 13 yrs of age.
Previous cycles were regular, with 3-4 days flow every 30 days.
LMP - exact date is not known.

Obstetric History: Married 6 yrs back, G3 P2 L2 A2

G1 was full term normal home delivery ... 4 1/2 yrs old living male child, ... Had not received any
antenatal or postnatal care, ... No H/O Ante-partum or post- partum hemorrhage.

G2 was also a full term normal home delivery, .. 2 yrs old living female child, ... Had not received
any antenatal or postnatal care, ... No H/O excessive bleeding, ... No H/O fever or foul smelling
lochia after the delivery.

G3 is the present pregnancy. This is her first antenatal visit.

Past History:
There is no Past H/O Tuberculosis, Hypertension, or Diabetes.

Family History:
No H/O Diabetes, Hypertension or any major illnesses in the family.
No H/O Pregnancy Induced Hypertension or Twins in the family.

Personal History:
Sleep, appetite are normal.
Bowel habits are normal.

On General Examination,

Cassette-Clinics of Dr Ghanashyam Vaidya 11

Patient is averagely built and poorly nourished.
Height is 152 cms, ... Weight is 45 kg.
Pulse is 96/min, regular, bounding character.
Blood pressure is 110/70 mm of Hg.
Respiratory rate is 18 per min, regular.

There is moderate degree of pallor, Nails show Koilonychia.

There is mild edema over the legs.
No signs of Congestive cardiac failure ie. JVP is normal, No basal crepts, No tender hepatomegaly.

Per abdomen,
Liver and spleen are not palpable.

Height of the uterus corresponds to 20 weeks,

It is soft, and external ballotment is present.

Respiratory system is normal, no adventitious sounds.

Cardio-vascular system: There is tachycardia, and a soft systolic murmur without a palpable thrill
in the pulmonary area - not conducted to other parts of precordium.

My diagnosis is : Third Gravida, ... with 20 weeks pregnancy, ... with anemia, ... probably Iron
deficiency anemia.

Cassette-Clinics of Dr Ghanashyam Vaidya 12

CASE NO. 05

PREGNANCY WITH PREVIOUS LSCS

This is the fifth case presentation, in the series of Cassette- Clinics in Obstetrics and
Gynaecology, prepared by Dr. Mrs. Swati Vaidya.

23 yrs old 2nd Gravida, Sunita Patil from Sangli, comes with H/O 8 1/2 months amenorrhoea, for
antenatal checkup.

Menstrual History:
• Menarche at 13 yrs, regularly menstruating with 3-4 days moderate flow.
• L.M.P. is 24th March 2009
• E.D.D. is 31 st December 2009

Obstetric History: Married 3 yrs back.

Gravida 2, Para 1, Living 1, Abortion 0

Gravida 1 was Full term Caesarian section at Government Hospital, 2 years back, Living male
child. The exact indication for Caesarian section is not known to the patient, but it probably it was
cephalo-pelvic disproportion.
The previous caeserian section was performed under General Anesthesia.
The Baby's weight was 3.2 kg.
No H/O Puerperal pyrexia, wound infection or foul smelling lochia.

Past History :
No H/O Hypertension, Diabetes, Kidney disease or any major illness in the past.

Family History:
No H/O Diabetes, Hypertension or any major illnesses in the family.
No H/O Pregnancy Induced Hypertension or Twins in the family.

On Examination,

Height is 145 cms., Weight is 54 kg.

Pulse is 84/ min, regular. Blood pressure is 110/70 mm of mercury.
There is mild pallor, no edema.
Respiratory and cardio-vascular systems are normal

Per abdomen,
Linear infra-umbilical midline scar is seen.
Uterine height corresponds to 36 weeks, and is 32 cms,
So, Estimated fetal weight is 3100 gms.
Estimated fetal age is 37 weeks.
Abdominal Girth is 58 cms.

On Palpation,
Breech is felt at the fundus, .. Back is felt on the left side, ... and limbs on the right side.

Cassette-Clinics of Dr Ghanashyam Vaidya 13

On Pelvic grips, Head is floating and ballotable, with occiput and sinciput at the same level.
So, it is a longitudinal lie, with cephalic presentation, and left anterior oblique position.
No scar tenderness.
Head fitting test is negative.

On Auscultation,
FHS are best heard between umbilicus and left anterior superior iliac spine, 140/ min, regular.

My Diagnosis is,
2nd Gravida, with 36 wks pregnancy, with longitudinal lie, cephalic presentation, in left occipito-
anterior position, with previous LSCS with Cephalo-pelvic disproportion.

Cassette-Clinics of Dr Ghanashyam Vaidya 14

CASE NO. 06

TWIN PREGNANCY

This is the sixth case presentation, in the series of Cassette- Clinics in Obstetrics and Gynaecology,
prepared by Dr. Mrs. Swati Vaidya.

22 yrs. old 2nd gravida, Vidya Joshi, a housewife from Sangli, with History of - 8 months
amenorrhoea, coming for ANC check up, complains of

• Over distension of abdomen

• Swelling over the legs, and
• Excessive fetal movements.

No H/O Excessive vomiting in early pregnancy

No H/O PV Bleeding, leaking or pain in abdomen

No H/O Scanty urine, Dysuria or Urinary complaints.
No H/O Leg edema prior to pregnancy.
Compared to her last pregnancy, she feels that the abdomen is showing more distension. There is
H/O mild Dyspnoea on lying down.
No H/O Dilated veins on legs
No H/O Bleeding P.R.

Looking for the cause of overdistension,

No H/O Induction of ovulation
No H/O Taking contraceptive pills
There is No H/O Diabetes in the patient,
No History suggestive of Rh iso-immunisation i.e.
No H/O Neonatal Jaundice in the past
No known Rh negative status.

Menstrual History - Menarche at 13 years.

Regularly menstruating woman, with 3-4 days flow every 30 days.
LMP on 3rd Oct. 2009, Expected date of delivery - 10th July 2010

Obstetric history - married 5 yrs back, G2 P1 L1 A0.

G1 was full term normal Hospital Delivery. 3 yrs. old male living child. Has received 2 doses of
Tetanus toxoid in the 1st pregnancy.

Past History: No H/O Diabetes, Hypertension or any other major illness.

Family History:
No H/O Twin pregnancy or Pregnancy Induced Hypertension in the family.
No H/O Diabetes, Hypertension or any major illnesses in the family.

Personal History:

Cassette-Clinics of Dr Ghanashyam Vaidya 15

Sleep is disturbed due to abdominal distension
Apetite is good.
Bladder, Bowel habits are normal. No H/O PR bleeding.

On Examination,

• Patient is averagely built and fairly nourished.

• Height is 150cms .... Weight is 56 kg.
• Pulse - 90/min, regular.
• Blood pressure is 120/80 mm of mercury in left lateral 15° tilt. .. Roll over test is negative.
• There is mild pallor of the mucosa, and bilateral pitting edema.
• Respiratory system is normal, no adventitious sounds.
• Heart sounds are normal, no murmur.

Per abdomen,
On Inspection,

Uterine height corresponds to 36 weeks, ie. 4 weeks larger than the period of gestation - and it is
33cms. As measured from the symphysis pubis.
Striae gravidarum and linea nigra are seen.
Umbilicus is protruding, other hernial sites are normal.

On Palpation,

Height of uterus is 32 weeks.

Two ballotable round, hard, structures are palpable on right and left grips, one in right iliac fossa,
and other in left hypochondriac region.
Multiple fetal parts are felt.
Excessive fetal movements are felt.
There is no fluid thrill.

On auscultation, FHS are heard clearly at two different sites.

My Diagnosis is,

Second Gravida with 8 months amenorrrhoea, with twin pregnancy, with longitudinal lie, ... one
vertex and one breech.

Cassette-Clinics of Dr Ghanashyam Vaidya 16

CASE NO. 07

PREGNANCY WITH BREECH PRESENTATION

This is the Seventh case presentation, in the series of Cassette- Clinics in Obstetrics and
Gynaecology, prepared by Dr. Mrs. Swati Vaidya of Karnatak Health Institute, Ghataprabha

23 yrs old 2nd gravida, Savita Deshpande, a housewife from Ghataprabha, comes with History of 9
months amenorrhoea, for antenatal check up.

She is having no complaints.

Menstrual History:
Menarche at 14 yrs age, Menstrual cycles regular 4/28 days, moderate flow,
LMP is 28th September 1989.
EDD is 27th June 1990.

Obstetric History :
She is married 4 yrs back,
Obstetric status – G1 P1 L1 A0

G1 was full term breech delivery in Hospital, 2 yrs. living female child. Baby cried immediately
after birth. Weight of the baby is not known. She had not received any antenatal check up in that
pregnancy.

G2 is the present pregnancy. She came once in the 6th month and has received one dose of Tetanus
toxoid.

Past History:
No H/O Diabetes, Hypertension or any major illness in the past.

Family History:
No H/O Diabetes, Hypertension or any major illnesses in the family.
No H/O Pregnancy Induced Hypertension or Twins in the family.

Personal History:
Sleep, appetite are normal.
Bladder & bowel habits are normal.

On General Examination,

The patient is averagely built and averagely nourished.

Height is 152 cms, Weight is 54 Kg.
Pulse is 90/min, regular.
Blood pressure is 110/70 mm of mercury, in right upper arm in 15° left lateral tilt.
There is mild pallor. ... No edema.
Respiratory system is normal, no adventitious sounds.
Heart sounds are normal, no murmur.

Cassette-Clinics of Dr Ghanashyam Vaidya 17

Per abdomen, on inspection,

Striae gravidarum and linea nigra are seen.

Height of uterus corresponds to 36 wks.

Height of uterus in cms is 32 cms.
Estimated fetal weight is 3100 Gms.
Estimated fetal age is 37 weeks.
Abdominal Girth is 59 cms.

On Palpation,
On Fundal grip, hard, round, ballotable head is felt.
Curved back is felt on the left side, and knob like limbs on the right side.
Firm, irregular, non-ballotable breech is felt on pelvic grip.

On Auscultation,
FHS are heard just above and to the left of the umbilicus, 140 / minute, regular.

My diagnosis is : 2nd gravida, with 36 wks pregnancy, with longitudinal lie - breech presentation,
.. with left sacro-anterior ie. Breech1 position.

Cassette-Clinics of Dr Ghanashyam Vaidya 18

CASE NO 08

BLEEDING IN EARLY PREGNANCY

This is the Eighth case presentation, in the series of Cassette- Clinics in Obstetrics and
Gynaecology, prepared by Dr. Mrs. Swati Vaidya of Karnatak Health Institute, Ghataprabha

22 yrs old female patient Anusuya Chougule, a housewife from Kalloli, was admitted in this
hospital on 23rd April 2009

She came with H/O 4 months amenorrhoea, complaining of pain in abdomen and PV bleeding since
1 day.
Patient initially had spotting and then the bleeding increased in quantity and is bright red in colour.
No H/O passing Vesicles.

Menstrual History:
Menarche at 13 yrs.
Regularly menstruating, with 3 to 4 days flow every 30 days.
LMP: on 4th Jan 2009

Obstetric History:
Married 4 yrs back. G2, P1, L1, A0.
G 1 was a full term, normal hospital delivery 2 yrs living male child.
G2 is the present pregnancy.

Past history:
No HIO Diabetes, Hypertension or Tuberculosis in the past.

Family History:
No H/O Diabetes, Hypertension or any major illnesses in the family.
No H/O Pregnancy Induced Hypertension or Twins in the family.

Personal History :
Sleep & appetite are normal. Bowel, bladder habits are normal.

On General Examination:

Averagely built, averagely nourished.

Height is 152 cms., Weight is 46 Kgs.
Pulse is 90/minute, regular, good volume.
Blood pressure is 110/70 mm of mercury.
There is mild pallor, no edema.
Heart sounds are normal, no murmur.
Respiratory system is normal.

On inspection of the abdomen,

Cassette-Clinics of Dr Ghanashyam Vaidya 19

Striae albicantes and Linea nigra are seen.
Uterus is just palpable at symphysis pubis.

There is mild tenderness in hypogastrium, no guarding or rigidity.

My Diagnosis is,

This is a case of 2nd gravida, with 4 months amenorrhoea, with PV bleeding, probably due to
inevitable abortion.

Cassette-Clinics of Dr Ghanashyam Vaidya 20

CASE NO. 09

PURPERIUM

This is the Ninth case presentation, in the series of Cassette- Clinics in Obstetrics and Gynaecology,
prepared by Dr. Mrs. Swati Vaidya, of Karnatak Health Institute, Ghataprabha

25 yrs old patient, ... Sunita Kadam, ... a housewife from Nagpur, … was admitted to this hospital,
on 20th February 2009, with history of 9 months amenorrhoea, and delivered on 21st February at 8
am.

She has no complaints.

Menstrual History :
Menarche at 13 yrs of age, ... regularly menstruating woman, ... with 3-4 days flow every 30 days.
LMP was 14th May 2008

Obstetric History : G2 P2 L1 A0,

G1, was a full term normal delivery, with Episiotomy.
4 yrs old, living male child.
No H/O antenatal, intranatal or postpartum complications.
Received 2 doses of Tetanus Toxoid injections.

G2 is the present full term normal Hospital delivery on 21 st February.

Living male child, weight 3.2 kg.
Has taken 2 doses of Tetanus Toxoid intranatally.

History of Labour:
Patient was admitted on 20th February, with mild labour pains, ... There was no leaking . . .. Soap
water enema was given.

She started getting strong pains from 10 pm, Membranes ruptured at 6 am next morning, The first
stage lasted for 8 hours. The second stage lasted for 1/2 hour and the placenta delivered within 15
minutes.

No H/O Post-partum hemorrhage.

Baby cried immediately after birth.

History of the Newborn:

Male living child. Birth weight 3.2 kg.
Started breast-feeding from the post-natal day passed urine and motion,
Heart sounds are normal, chest is clear.
Moro's, sucking and rooting reflexes are normal.
No external congenital anomaly detected.

Past History:
No H/O Diabetes, Hypertension, Tuberculosis, or any other Major illnesses in the past.

Cassette-Clinics of Dr Ghanashyam Vaidya 21

Personal History :
Sleep and appetite are normal.
No Bladder or Bowel complaints.

On Examination,
Patient is averagely built and averagely nourished.
Pulse is 90/ min, regular, good volume.
Blood pressure is 110 / 70 mm of Hg,
Patient is afebrile.
There is mild pallor, no edema, icterus or cyanosis.
Respiratory system is normal, no adventitious sounds.
Heart sounds are normal, no murmur.

On Examination of Breasts,
Breasts are slightly engorged and tender, nipples are normal, and yellowish white milk can be
expressed,
No cracks, fissures or retraction of nipple,

On Examination of abdomen,
On inspection, ... the abdomen is lax, Linea nigra and striae gravidarum are seen.
A supra pubic bulge is seen.
On Palpation, ... Abdomen is soft,.
Uterus is globular, hard, 1" below the umbilicus.
Liver and spleen are not palpable

On Examination of the Lochia,

Lochia Rubra is present, 1-2 pads per day, No foul smell.

My Diagnosis is : Second Gravida with normal delivery, on fourth day of uncomplicated

purperium.

Cassette-Clinics of Dr Ghanashyam Vaidya 22

 CASSETTE CLINICS
THE HOUSE OF AUDIO-VISUAL CDs

1. CASSETTE-CLINICS – ‘VIDEO’ ~ VIDEO-CD sets.

Video-CDs can be viewed on “VCD player + TV’ or on computer

Educational Films for Medical students and Practitioners

1. ECG: (A set of 3 video-CDs – Rs. 450 only)* Most popular

This presentation begins with introduction to PQRST waves, and teaches all common
ECGs that a MBBS graduate is expected to recognize.
A simplified approach, a unique way of presentation, with hundreds of actual ECGs and
diagrams, help you to master the basics of this topic and learn to diagnose common
conditions at a glance. Duration: 3 hrs.

2. G.P.CLINICS VIDEO: (A set of 3 video-CDs – Rs. 450 only)

This presentation begins with Basic Examination techniques in General Practice. The
second section (2 hrs15 mins.) demonstrates a large number of Clinical signs in Medicine
& Surgery, which are commonly encountered in General Practice – Live pictures, next
best to actually examining a case.
Also includes 45 assorted cases in quiz format. Third section demonstrates common
procedures for the Family doctor. Duration: 3 hrs.

3. RADIOLOGY [X-Ray Reading]: (A set of 5 Video-CDs – Rs. 750 only)

This is a set of 5 CDs, about 1 hr. each, covering practically all aspects of X-ray reading
required in day-to-day practice.
There are hundreds of X-ray pictures systematically presented and explained, neatly
labeled for clear understanding, and explained in a very simple, easy to follow manner
( which is the hallmark of all Cassette-Clinics cassettes).
The topics covers are – i) X-ray Chest in Tuberculosis, ii) X-ray chest in other diseases, iii)
The cardiac shadow iv) X-ray of the abdomen. v) X-ray KUB, vi) IVP, vii) Barium meal
study and viii) Orthopedics.

4. OPERATIVE SURGERY FOR UNDERGRADUATES: (A set of 3 video-CDs – Rs. 450

only)
A step-by-step demonstration and explanation of all common operations that a MBBS
student is expected to see and understand.
Crystal clear pictures shot through the surgeon’s eye, clearer than you may actually see in
the operation theatre. Covers about 49 operations and Instruments.
Duration: 3 hrs.

5. THE ART OF BANDAGING: (A set of 2 video-CDs – Rs. 300 only)

Cassette-Clinics of Dr Ghanashyam Vaidya 23

Demonstration of all Bandages from head to toe, in scientific methods. Principles and key
steps of each bandage explained. Total 37 different Bandages. Ideal for Doctors as well
as for Paramedical staff training in Nursing homes. Duration: about 2 hrs.

6. CLINICAL EXAMINATION IN SURGERY: (A set of 4 Video-CDs – Rs. 600 only)

Learning Clinical Surgery will never be the same again - A revolutionary approach to
learning Surgical cases. It’s like watching a movie! Just sit back and enjoy viewing the
Methods of Examination and Clinical Signs in Surgery, which you just read about in Das or
Hamilton Bailey. Learn by actually seeing the cases and not by imagining. To be viewed 5
times in 3 years. L.. A must for 2nd & 3rd MBBS students, because it makes a difference in
the understanding. Subsequent reading and memorizing of textbooks becomes easy. So
much, that no student can afford to miss it.
Topics: Examination of Swelling, Ulcer, Hydrocele, Hernia, Thyroid, Breast lump, PVD,
Varicose
veins, Lump in abdomen. Duration: hrs.

2. BOOK
GENERAL PRACTICE: A Practical manual ~ 4th Edition [June 2010]

The most useful book for every practitioner, covering all aspects of General Practice.
A detailed symptom-wise prescriber, a systematic Clinical approach for each symptom,
Emergencies, Procedures, Hints to start a new Practice, Record keeping, Medicolegal
aspects, Drug index, Practical hints and Medical Ethics.
New Additions = Instant Relief, Diet & Exercise prescriptions, Medical Camps,
Traveler patient, More symptoms covered and all therapeutics updated, Audio
Lectures.

• The Largest selling book on General Practice, now in fourth edition, with FREE CD
• The book proven to be the best colleague on table for every practitioner for last
more than ten years
• 60000 + copies sold

Published by: Bhalani Publishing House, Mumbai

Cassette-Clinics of Dr Ghanashyam Vaidya 24

 3. CASSETTE-CLINICS – ‘AUDIO’
Audio-CDs can be played on Audio player + TV’ or on computer

Ideal Case-presentations for MBBS students

The most popular and useful cassettes for Medical studentsL.A live discussion between a
student and his teacherL.with step-by-step analysis of every point in History and every
finding on Clinical
ExaminationL.The perfect clinics that leave no questions unansweredLThey also teach
you to ‘speak out’ what you know .. Used by over by 35,000 MBBS & PG students over
last 18 years.

SURGERY SET
- Now as MP3 CD with e-book. Previously- A set of 5 cassettes and a booklet

Covers 9 Long cases: Inguinal swelling, Inguinoscrotal swelling, Non-healing ulcer,

P.V.D. with Gangrene, Thyroid, Breast lump, Lump in abdomen, Varicose veins, and
Tuberculosis of Spine. And
several short cases.

MEDICINE SET
- Now as MP3 CD with e-book. Previously- A set of 6 cassettes and a booklet

Covering all important Case presentations in Medicine.

AS: Hepatomegaly, Splenomegaly, Jaundice, and Ascitis. RS: Pleural effusion, Cavity with
fibrosis. CVS: Mitral stenosis. CNS: Hemiplegia, Paraplegia. Special Feature: Heart
sounds and Breath sounds.

OBSTETRICS SET
By Dr. Mrs. Swati G. Vaidya MD (Gyn)
- Now as MP3 CD with e-book. Previously- A set of 4 cassettes and a booklet

Covers 9 Obstetric cases: Antenatal check up, Pre-eclamptic Toxemia, Heart disease,
Anemia, Previous Caesarian, Twins, Breech, Bleeding in Pregnancy, And Puerperium.
(With detailed discussion of investigations and treatment). Also includes Plan of treatment
of Gynecological disorders.

Recommended for students: Set of three Audio CDs + Video CDs- (1) Clinical examination
in surgery, (2) Operative surgery & (3) GP Clinics video
Recommended For General Practitioners: The Book + Video CDs- (1) GP Clinics Video,
(2) ECG & (3) Radiology. (+ Other CDs, if of interest)

Cassette-Clinics of Dr Ghanashyam Vaidya 25

 BHALANI MEDICAL BOOK HOUSE
11, Mavawala Building, Opp. Seth G.S. Medical College &
K.E.M. Hospital, Parel, Mumbai 400012
Tel.: (91+22) 2414 0220 / 2414 0942
Fax: (91+22) 2413 8041
E-mail: [email protected] • [email protected] • Website: www.bhalani.com

01/01/2010
Ordering Information

Customers from Mumbai can order their requirements either by e-mail or over telephone and the
supply will be arranged to their address with nominal delivery charges. Payment will be collected
in cash against delivery.

Customers from out of Mumbai can order their requirements either by e-mail or over telephone and
supply can be arranged by any of the following mode-

1. By making payment in advance through cheque/draft in the name of Bhalani Medical Book
House and forward by post/courier to our address and the supply will be arranged by
post/surface courier for direct delivery. (No any commission payable & only postage
charged) (Delivery 3 to 5 days).

OR

Deposit cash/cheque with any of the following banks near to you of -

A) HDFC Bank- account No. 03572000002955 in the name of Bhalani Medical Book
House, Mumbai
B) Canara Bank- account No. 0110261021624 a/c in the name of Bhalani Medical Book
House, Mumbai

And the supply will be arranged by surface courier for direct delivery. (Courier charges
extra and no any commission payable) (Delivery 3 to 5 days)

Latest Price list:

These prices are valid for 2010. Ask for the latest pricelist first.

Video CDs: Prices as mentioned above + Postage Rs. 50/- for 1 set, Rs 100/- for 2 or
more sets.
Audio CDs (3): Rs.450/- [Surgery CD + Medicine CD + Obstetrics CD] + Postage Rs. 50/-
= Rs.500/-
Book: General Practice –A Practical manual, 3rd Edition, Price Rs. 395/- and discounted
Rs. 350/- inclusive of postage.

Cassette-Clinics of Dr Ghanashyam Vaidya 26

How to order:

Payment by M.O. (Money order by Post), or D.D. (Bank Demand Draft) In favor of
“Bhalani Medical Book House”, payable at Any Bank at ‘Mumbai’. Or payment on bank
account as mentioned above.
Order should be accompanied by a letter mentioning your complete postal address
and the list of CDs and books required.
On receipts of payment, The CDs/Book are dispatched by surface courier.

CDs and book are also available at all major Medical Booksellers in India and from
the author.

For your queries, difficulties or suggestions about the case presentations,

Please contact –

Dr. Ghanashyam Vaidya, Karnatak Health Institute, Ghataprabha, Taluka: Gokak

Dist: Belgaum, Karnataka, PIN: 591 306, [email protected]

Cassette-Clinics of Dr Ghanashyam Vaidya 27