Case discussion- PV leaking liqour

Discussion points:

further history of per vaginal leaking of fluid:
colour, amount, smell, blood?, pain?, mucus?
trauma/fall?, onset, after sexual intercouse?,
is it sign of labour?

is it from vagina/ urine? colour, odour

2 full term vaginal deliveries:
episiotomy, spontaneous/ induced?, complication,
any congenital abnormalities

Booking, as early as 10 weeks
how you suspect pregnancy? (UPT +ve?)
reason for late booking?
parameters?
height, weight, bp, urine protein&glucose, VDRL,
HIV, Hep B, Hb, blood group, rhesus

examples of hematinics,
Folate, Vitamin B12/B complex, Iron(Ferrous sulphate),
Vit C

Calcium

Obimine/Orbical

Slightly overweight, PR slightly increased,

Febrile(high grade):
baby temperature is 39.5
onset, pattern,
nausea, vomitting
URTI: chills, rigors, night sweat, sorethroat, cough
UTI: painful micturition, itchiness
any reduced fetal kicks?
immunization: ATT, Rubella (school times?) , Hep B
Primigravida: 2 dose ATT
Multigravida: 1 dose ATT

fever,
exo/endo pyrogens-->macrophages, T-cell produces interleukin-->
hypothalamus produces prostaglandin E2---> increase temp set point
-->muscles contract produce heat

3rd trimester: 28-40th weeks

Possible causes of leaking liquor:
UTI, sign of labour, premature rupture of membrane

earliest to detect pregnancy:22 days after LMP

when does the fetal heart started to be heard?
when mother can feel kicking?

FBC: check for infection(WBC count)
patient pallor in PE? check for anemia (Hb)
VDRL, Hep B,

Blood C&S, check for infection

Urine FEME, C&S

Vagina swab: source of infection

TPHA?

A+, Hep B surface antigen n antibody -ve, VDRL +ve in low dilution
HIV screening -ve, Hb 11.8, WBC: 16x10^9,

Vagina swab: beta hemolytic group B streptococcus

TPHA: Trepenoma pallidum

Learning issues:

1. causes of leaking fluid + causes of fever during pregnancy, harm to the fetus 
2. immunization during pregnancy + TORCHES( vertically transmitted infection) 
3. normal pregnancy changes? weight increased during pregnancy, guidelines?
4. reasons for smaller/larger symphysio-fundal height
5. antennetal checkup schedule, baseline
6. Iron requirement during pregnancy
7.when does the fetal heart started to be heard? + Principles of cardiotocography + when mother can feel kicking?
8. significance of screening for Hep B, HIV;
9. importance of TPHA, principle of test VDRL, Normal flora of vagina 

10. indication for dexamethasone + principle of choosing antibiotics for pregnant mother
11. Criteria & causes of fetal distress
12. Physiology of liqour, causes of poly, oligo and treatment + Amniotic fluid index, how to determine poly/ oligo