THE UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH
TANGANYIKA MEDICAL TRAINING BOARD
MLIMBA INSTITUTE OF HEALTH AND ALLIED
SCIENCES
CASE REPORT FOR CONTINUOUS ASSESSMENT-
ASSIGNMENT II
APPRENTICESHIP IN OBSTERTRIC AND
GYNERCOLOGY

NAME:ISACK OMWANGA SOTI

REGISTRATION NO:NS5362/0027/2018

NTA LEVEL…………………………… 6

ACCADEMIC YEAR...................2022/2023

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TABLE OF CONTENTS
Summary/abstract………………………………………………………………3
Acknowledgement………………………………………………………………3
Introduction………………………………………………………………………3
PART ONE Patient history
Patient demographic
data…………………………………………………………………………4
Chief complaint and
duration………………………………………………………………………4
History of presenting
illness…………………………………………………………………………5
Review of other
system…………………………………………………………………………6
Past medical
history…………………………………………………………………………6
Family and social
history………………………………………………………………………..…7
PART TWO Physical examination
General examination…………………………………………………………….8
Abdominal examination………………………………………………………….8
Respiratory system
examination………………………………………………………………………8
Cardiovascular system
examination……………………………………………………………………..8
Nervous system examination…………………………………………………….9
PART THREE Diagnosis
Provisional
diagnosis……………………………………………………………………………9
Differential diagnosis……………………………………………………………..9
Finaldiagnosis……………………………………………………………………..9
Investigation ordered with their
results……………………………………………………………………………..9
PART FOUR Treatment
Follow up…………………………………………………………..9
Plan………………………………………………………………….9
PART FIVE Discussion in relation to the final diagnosis
PART SIX Conclusion and remarks
Conclusion…………………………………………………….9
Lesson learnt……………………………………………………….9
Recommendation ……………………………………………………9.
References……………………………………………………………….10

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 ACKNOWLEDGEMENT
I would like to thanks Almighty God for giving me the ability of participating and
learning during the rotation in the obstetrics and gynecology ward.
Also much thanks to MIHAS management for providing information and directions
toward the completion and achievement of my goals fore most to the Principal
DR Mwakanyamale and academic DR Myembe
Also great full thanks to hospital management for allowing me to conduct rotation in
the hospital for the purpose of learning
Much thanks to Dr.HERMANand Dr, ALLERN for taking their time and joining with
us at the clinical area, teaching and implementing some knowledge to us.
Also much thanks to nurses supervisor in pediatrics ward for being with me during my
learning in the ward
Thanks to the class representatives CRs for their contribution on providing with
information on what to do at the certain time

ABSTRUCT
This happens when the mother after delivery develop signs of eclampsia like convulsion and
proteinuria, in deed other signs like headache and raised blood pressure
 Our patient developed raised blood pressure and loss of consciousness
 Also was given iv medication and was resolved.

INTRODUCTION
The case was collected in the post natal word after two days from the patient
And the consent was obtained from the patient and confidentiality was assured

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DEMOGRAPHIC DATA
Name: Geni Makanyaga
Age: 27yrs
Sex: female
Occupation: peasant
Marital status: married
Address: Mlimba A
Religion: Christian
Trible: bena
Date of admission: 06/06/2023
Date of taking history: 08/06/2023

CHIEF COMPLAINT.
Lower abdominal pain for 5 hours

HISTORY OF PRESENTING ILLNESS

The patient was apparently well until 5 hours ago prior to admission. When she started to
experience the gradual onset of lower abdominal pain cramping in nature, radiating to the back,
increase in intensity as time goes and intermittent. No aggravating factor and relieving factor.
The pain was associated with per vaginal discharge which is mucoid stained with blood.
The patient denied history of nausea and vomiting, loss of appetite, passing of lose stool,
increase in frequency of urination, painful in urination and blood in urine. On admission per
vaginal examination was done and was told that the cervix started to dilate.
However, the patient reported the pain to the previous scar that was done on September 2021.
According to the condition of the patient was told by the doctor to prepare for emergency
operation, pre-operative care was done and around 10:00 a.m the patient was taken to operation
room. during operation they extracted a baby girl weighing 3 kg. she was told by the nurse that
the baby cried immediately and was given glucose before the mother wake up from anesthesia.
Now the baby continues well and able to breastfeed has no other complication.
But the mother after awake from anesthesia she lost consciousness and had diagnosed to
have an increase in blood pressure which is 181/120mmhg with no history of heart beat
awareness no history of easily fatigue, no history of difficulty in breathing, no history of lower
limb edema,started medication immediately after the condition. Also reported the same condition
to the previous pregnancy. But she denied the history of convulsion, blurred vision, headache,
fever and dizziness.
Currently the patient is complaining pain at incision wound which is sharp in nature. Which is
localized at the incision area aggravated when changing position and doing any exercise like
walking, relieved by sitting and lying flat and by taking medication, has o any associating factor.

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REVIEW OF OTHER SYSTEM
Muskloskeleto system
No history of joint pain
No history of joint swelling
No history of muscle pain.
Ear, nose and throat
No history ear discharge
No history eye discharge
No history difficult in swallowing

PAST OBSTETRIC HISTORY

She booked at Maswa RCH when the pregnancy is at 16 weeks of GA. Screened for HIV,
syphilis, malaria, and the result was negative. She was given treated mosquito net, sp and fefo
also was given tetanus vaccine.

Year Gende Mode GA Place Weight complication Status

r of
delivery
2021 Male c/s 39weeks Hospital 2.8 kg Mother got Living
eclampsia
and
No
complication
to the child
Complication on during previous pregnant:-
But the mother developed the condition of increase in blood pressure, respiratory rate and pulse
rate.

GYNECOLOGICAL HISTORY
She started her menarche when she was 12years, took 3 days and change pad 5 times a day
which is not full soaked, the whole cycle takes about 28 days. No history of gynecological
surgery. no history of contraceptive use and history of STI’s.
PAST MEDICAL HISTORY
Has no history of medical admission but has the history of obstetric case which is her second
admission, has no history of blood transfusion. no history of surgery, no history of chronic illness
like diabetes mellitus, HIV, TB.

FAMILY AND SOCIAL HISTORY.

She is standard 7 and her husband is the form four leaver, they are peasant. There are 4 members
in the family .has no history of inharetence disease like hypertension, diabetes mellitus, sickle
cell.

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GENERAL EXAMINATION
The patient is alert, ill looking with normal hair colour texture and well distributed , no jaundice
per sclera, no pallor per conjunctiva, no ear, eye, and nose discharge no angular stomatitis no
oral thrush and cyanosis, no lymph node enlargement, no palm pallor, normal capillary refill, no
finger clubbing cannulated on the right hand side and no lower limb edema.
Vital signs
Blood pressure =140/90 mmhg
Respiratory rate= 18 b/min
Pulse rate= 104 b/m
Temperature-=37oC

SYSTEMIC EXAMINATION.
Per abdomen
Inspection
Abdomen moves with respiration, there is surgical wound. No tradition and traumatic scar. There
is linear nigra.

Palpation
Tenderness around the incision wound. uterus is palpable. No liver and spleen enlargement.
Kidney were not ballotable.
Percussion.
Tympanic note was heard. But dull at the sit of uterus.
Auscultation
Bowel sound were heard.

Respiratory system.
Inspection.
Normal chest cage, ,no tradition and surgical marks,no visible mass
Palpation
Trachea is centrally located,equal chest expansion, normal tuctile vocal fremitus.
Percussion
Resonant note
Auscultation
Vesicular sound was heard.
Cardiovascular system
From inverted J
Warmth extremities pulse rate are strong regular- regular, no finger clubbing , no jugular venous
distention .apex beat is located at the fifth intercostal space along the midclavicular line.S 1 and S2
were heard with no added sound

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Central nervous system
Higher center
The patient was alert oriented to people, time and place intact in both short term and long term
memory as she was able to remember when started schooling
Cranial nerves examination
Cranial nerves tested both were intact
CN I: Olfactory • the patient was able to smell the soap smell each nostril with smells of soap
and cranial nerve I was intact.CN II: Optic
the patient was able to differentient the colour of primary colour which was white and black.
Which was intact.
CN III, IV, VI: Oculomotor, Trochlear, Abducens
The patient was able to follow the finger with eyes without moving head’tested by the six
cardinal points in an H pattern which was intact.
CN V: Trigeminal Corneal reflex: patient looks up and away and touched with cotton wool to
other side and patient was blink and sense due to that was intact.
CN VII: Facial
The patient was able to smile symetrical, was able to form wrinkles and was able to bow chicks.
CN VIII: Vestibulocochlear
The patient was able to hear the sound of rubbed nail when both eye are closed in each ear
separately.
CN IX, X: Glossopharyngeal, Vagus
The patient was able to swallow and the uvula was central located.
CN XI: Accessory
The patient was able to shrug the shouder against resistance.
CN XII: Hypoglossal
The patient was able to potrude the tongue.
Motor examination
Motor activity tested with normal muscle power which was 5/5 in upper and lowel limbs normal
muscle tone, normal muscle bulkiness no muscle folliculation the elbow and knee reflex tested
were normal
Sensory examination
The patient was responding both sensory stimulation both pain, vibration and light touch

SUMMARY.
A 27 years old female from Mlimba A P2L2 comes with the complaint of lower abdominal pain
for 4 hours prior to admission cramping in nature radiating to the back associated with blood
stained mucus. it was associated with pain at the previous scar thus caused to deliver by
ceaserian section. after delivery she lost conscious after awake from anesthesia also there was an
increase in blood pressure and pulse rate. on examination blood pressure was 140/90 mmhg and
pulse rate 104 bpm.

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PROVSIONAL DIAGNOSIS
1. Resolved Post-partum pre eclampsia
Due to
Loss of consciousness
Increase in blood pressure after delivery
Has the history of eclampsia to the previous delivery.

2. 2 days post caesarean section

INVESTIGATION.
.-Urine for protein

.-Full blood picture (haemoglobin level)

-blood grouping and cross match to identify the blood donor
TREATMENT
Apply ABCD principle of resuscitation.
. Control the blood pressure
- Record BP every 4 hour
. Control the fluid balance - Give IV RL/NS slowly 1lt in 6-8 hours (40-50 drops/minute)
- • Insert an indwelling urethral catheter - Monitor input/output

POST OPERATIVE MANAGEMENT

At day 2 she should start light diet’
Ampiclox capsule 500mg oral 8hourly
Metronidazole tablet 400mg 8houry oral
Analgesics: continue with diclofenac (po) 50mg tds for 5 days
Ambulation: the patient should continue with walking without an assistance thus help to reduce
complication that may occur due to prolonged bed ridden
Exclusive breastfeeding
FOLLOW UP
Routine supervision and review a patient for a new complaints. If a new complaint(s)
arise treat them in early stage to prevent complication and deformities.

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DISCUSSION IN RELATION TO THE FINAL DIAGNOSIS
The next day during ward round the patient was reviewed
The patient has no new complain and also on examination no jaundice no paleness per
conjunctiva
All vital sign were normal
The wound is dry no pus so bandage has removed
The Doctor recommended wound dressing
Continue with previous medication
Second word
The patient reviewed with no new complain on examination no paleness no cyanosis
The wound was dry with no puss no blood
All vital were normal
The doctor recommended to discharge the patient

FOLLOW UP
After discharge patient should come back after 7days to remove the threads

PREVENTIVE MEASURES
• Regular antenatal checkup for early detection of rapid gain in weight or a tendency of
rising blood pressure especially the diastolic one.
• Antithrombotic agents: Low-dose aspirin 60 mg daily beginning early in pregnancy in
potentially high-risk patients is given. It selectively reduces platelet thromboxane
production. Aspirin in low doses is known to inhibit cyclo-oxygenase in platelets thereby
preventing the formation of thromboxane A2 without interfering with prostacyclin
generation.
• Heparin or low-molecular-weight heparin is useful in women with thrombophilia and
with high risk pregnancy. t Calcium supplementation (2 g/day) reduces the risk of
gestational hypertension.
• Balanced diet rich in protein may reduce the risk
CONCLUSION.
The disease is very serious so can cause high morbidity and mortality rate to the pregnant
women. So I advise all female of reproductive age and pregnancy to visit to the hospital for
proper management.
LESSON I LEARNT.
I leant that the disease can present with some features apart from that are normally occur in the
particular patient

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REFFERENCE.
Dutta text book of gynaecology
TREATMENT GUIDELINES Obstetric and Gynaecological Disorders

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