26/F G4P1L1A2 ?ITP
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Case:
26year female came to casualty as she was referred from outside hospital in view of thrombocytopenia in pregnancy
No previous comorbidities
HOPI:
1st pregnancy P1L1 ,5yrs male child ,LSCS in view of PROM
2nd pregnancy in view of bleeding PV visited hospital at 1 and half month Gestation--threatened abortion
3rd pregnancy- Spontaneous abortion,went to hospital for regular check up and was told to have absent Fetal heart sounds and was given Medication for MTP
After 1year patient was admitted in our hospital with fever ,low back ache ,headache and was told to have low platelets 34k,was managed with IV fluids ,improved to 1.05L at discharge and 1.5L later on follow up one week later
She did not have any bleeding manifestations at that time
After 1 year (this pregnancy) spontaneously conceived ,6months of amennorhea now
No use of any contraception in between the pregnancies
C/o bleeding from gums from 2days before admission while brushing teeth,petechial rash on right hand since 1day
She went on a regular antenatal check up at outside hospital and was found to have platelets 20k and was referred to our hospital.
No c/o hematuria,blood in stools,hemetemesis,hemoptysis
Ist Trimester -h/o vomitings (subsided later),no h/o fever with rash,no h/o radiation exposure,white discharge pv,spotting pv,early obs scan was normal
2nd trimester -quickenint felt at 5th month ,TIFFA normal done at 17 weeks
Lmp 6/4/2022
Edd 13/1/2023
Sedd 7/1/2023(9weeks,3days)
POG 25weeks +3days
Past history
No h/o DM ,HTN,CAD,CVA, Epilepsy, previous bleeding disorders
Personal history:
Diet- mixed
Appetite- normal
Sleep- Adequate
Bowl and bladder movements: regular
Menstrual history:
Menarche - 13years
3-5 Days/30 cycle
LMP- 6/04/2022
OBSTETRIC HISTORY :
Age at marriage- 18 Years
Age at first child birth- 20 Years
Gravida- 4
Para- 1
No. Of living children- 1
No. Of abortions- 2 at 6 weeks
GENERAL EXAMINATION:
After taking consent, the pateint was examined in a well lit room.
The patient is conscious, coherent, cooperative and we'll oriented to time, place and person.
She is thin built and moderately nourished.
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, Edema, dehydration.
Temperature - Afebrile
Pulse - 80bpm
Respiratory rate - 16cpm, regular
Blood pressure - 100/60 mmHg
SpO2 - 99% at room air.
Hess test negative
Systemic examination
CVS- S1 S2+
RS- BAE+
CNS- INTACT
Investigations
Day 1
Day 2
Day 3
PROVISIONAL DIAGNOSIS:
A 26 YEAR FEMALE, G4P1L1A2 with 25 weeks 3 days GA with previous LSCS with
?Gestational Thrombocytopenia
?ITP,
?APLA
TREATMENT:
Day 1
1. 1 SDP TRANSFUSION
2. Daily Fetal heart, Fetal movements count monitoring
3. T. FERROUS ASCORBATE 100MG PO/BD
4. T. CALCIUM 1000MG PO/BD
5. T. ULTA MW 500MG PO/OD
6. T. MVT PO/OD
7. GRBS MONITORING
Day 2
1.T. FERROUS ASCORBATE 100MG PO/BD
2.T. CALCIUM 1000MG PO/BD
3.T. ULTA MW 500MG PO/OD
4.T. MVT PO/OD
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