2. Name – Yeasmin akter
Age - 30yrs
Husband’s name -Boshir Ahmed
Occupation -House wife.
Address - Rangamati ,
Date of admission -30.01.2017
Date of examination-27.04.201
PARTICULARS OF THE PATIENT
4. H/O OF PRESENT ILLNESS
According to the patients statement she was alright one year back then she
became amenorrhoeic for 1.5 months, her pregnancy test was positive .
At 3 month of her pregnancy she noticed irregular p/v bleeding, which was
small in amount . With this complain she visited at GOPD, Rangamati
General Hospital .
She was treated with tab. metherspan 1 tab. TDS for 3 days on 11.07.16
but her p/v bleeding continued irregularly for a month which was moderate in
amount .
With this complain again she was admitted to the same hospital & advised
to do a USG of L/A & diagnosed as a case of incomplete abortion. She was
advised for MVA.
Her MVA was done on 10.08.16 by a staff nurse at Rangamati General
Hospital . The attending nurse mentioned that the product of conception
was grape like , but it was not sent for any examination & her bleeding
continued about a month after evacuation .
5. Then she attended GOPD at rangamati general hospital on 14.09.16 [0ne month after
evacuation] this time she was attended by a senior Gynae consultant and was advised
to do a s.β HCG from chittagong city [ done from chevron ; 61000 m IU/l ,5.09.16 ] .
With this report she was referred to CMCH for further management .
But she got admitted in a private hospital & received two unit of blood trasnsfusion ,
had some investigation s: [s.β HCG-8800.30 m IU /L ,11.09.16] referred to CMCH
for further Rx.
she went to AD –Din Hospital Dhaka ,
Diagnosed as a case of incomplete abortion
D & C done on ( 19.09.16 )[ 2nd time ]
investigations done at AD Din hospital :
s.β HCG 1782 m IU /L ( 21.09.16)
CBC :
HB%- 9.6 g/dl
ESR- 40 mm in 1st hr
WBC :
TC-8.63X10^3/ uL
Platelet -405x10^3/ uL
Histopatology report : suggestive of product of conception .
6. s.β HCG 3861 m IU /L ( 25. 09.16)
s.β HCG 3162m IU /L ( 01.10.16)
After that her bleeding stopped she returned to Rangamati with advice to came
F/U after two weeks .
But her bleeding starts 3/4 days after her discharge ,then she admitted herself
at AD – Din hospital after admission she had a
USG of L/A
impression : Suggestive of persistent trophoblastic disease with right ovarian
cyst.
so her gynecologist advised for hysterectomy but she refused .
Then she consulted with an other gynecologist of AD-Din was advised for
D & C. ;
.
7. On 6th november she had her 3rd D n C .
Tissue Send For Histopathology
Report :
Fragments of endometrial tissue show invasive foci of trophoblastic cells.
Features are suggestive mole or choriocarcinoma.
They referred her to DMC for further management . but she refused to take
treatment and went home .
She had on and off p/v bleeding which was not alarming . That’s why she didn’t
came for follow up .
Then around three months after she had severe p/v bleeding followed by
unconsciousness was admitted to Rangamati medical college on 29.01.17 .
there she was managed with two units of blood & referred to CMCH for
further management .
8. She admitted on our unit as an emergency case on 30.01 .17at 9.00 pm
On admission
Appearance –anxious
Anaemia – ++
BP- 90/70 mm of Hg
PULSE – 110 b/min
R/R –30 b/min
Heart – NAD
Lungs –NAD
U/O -100 ml
P/A/E: NAD
P/V/E:
Ut- bulky
Os – Closed
Bleeding – +
9. Management :
Diet : liquid
O2 inhalation 4-6 litter
INJ : plasmasol 500 ml
IV running
INJ. Hartsol 1L
IV running then
inj. Cefron 1 gm
IV stat then BD
cap. Omep 20 mg
1+0+1
continious catheterization
Blood trasnfusion 2 unit
10. (31.01.17)
CBC: Hb%- 8.8 gm/dl
S.β HCG – 225OOO m IU / ml
CXR-Normal
USG of L/A : ( Doppler study) :
suggestive of invasive mole
Packed cell 2 unit
With this report we gave on call to the radiation oncology department on 01.02.17 ,
they scheduled chemotherapy (EMA/CO) two weekly for the patient .
The patient had her 6th cycles of chemotherapy on 29/04/17.
13. SERUM Β .HCG CHART :
0
50000
100000
150000
200000
250000 Series 1
Series 1
14. H/O past illness:
She gave no H/O HTN,DM,Asthma
she gave h/o chronic constipation.
Personal History:
No H/o smoking and betel nut chewing.
Family history :
Nothing contributory.
16. MENSTRUAL HISTORY
Menarche at - 13 years
MP/MC : 3-4 d/28-30 d
LMP : can’t mention
Contraceptive history-
She took ocp irregularly for last 3 year
now she is using barrier method
20. Pulse- 80 beats /min
BP- 110/80 mm of Hg
Temperature- 98.4° F
Respiratory rate-14 breaths/min
Heart- NAD
Lungs- NAD
Thyroid gland – Not enlarged
Breasts- No abnormality detected
21. P/A EXAMINATION
No abnormality detected.
PELVIC EXAMINATION:
Inspection:
vulva & perineum looks healthy.
Per speculum:
not done
Bi manual examination:
Not done
Per rectal exam:
Not done
