Case Report of Dwarf Lady With 34+ Weeks Pregnancy [Photos]

This is a Case Presentation of a Dwarf Lady With 34+ Weeks Pregnancy. This presentation was prepared and presented by Dr. Zannatul Ferdaus (Akhi), Intern Doctor, Gynae Unit-I, Rajshahi Medical college, Rajshahi. I have made some modifications for my website. Share this with your Friends and let them have a chance to see it.

Case Report of Dwarf Lady with Pregnancy:

Mrs. Masura, a short stature lady, 28 years, Non-diabetic, non-hypertensive, Muslim, housewife of lower class family hailing from puraton parila, Bojorpur, Poba, Rajshahi admitted in gynae unit-I of RMCH on 02-06-2013 with the complaints of-

1. Amenorrhoea for 8 months.
2. Physical discomfort in her daily activities for last 1 months.

History of Present Illness:

According to statement of patient, she was regularly menstruating women with normal duration and average flow. Then she developed Amenorrhea but she could not accurately mention her LMP. But she was on regular antenatal check-up in Gynae out patient department of  RMCH.

Her  1st   antenatal visit was done on 10.11.12 by Rs, Gynea in Gynea out patient department & diagnosed as High risk pregnancy. Thorough investigations were done on that day. USG of pregnancy profile revealed single live pregnancy of 08 weeks & EDD- on 07.07.13. she suffered from morning sickness in her 1st  trimester. Her Bowel & bladder habit is normal.

Dietery habit is not satisfactory. Now a days she feels physical discomfort in her daily activities.  As she was diagnosed as a high risk pregnancy , she was advised for hospitalization for better management.

History of Past Illness:

She had no history of Bronchial asthma, Heart disease, Renal disease, Malabsorption syndrome, DM.

Family History:

Patient’s parents are alive. she has 3 brothers and 3 sisters. All are in average body built. No history of dwarfism in her maternal or paternal side.

Socioeconomic history:

She comes from a lower class family.

Personal history: 

She is nonsmoker & nonalcoholic.

Obstetric History:

Menstrual History:

1. Age of menarche – At 18 years.
2. Menstrual cycle-Regular
3. Menstrual period -2-3 days.
4. Menstrual flow – scanty. LMP-? [Could not mention accurately]
5. EDD- 07.07.13 (According USG)
6. She also gave history of delayed onset of puberty.

Contraceptive History:

She takes OCP as a contraceptive.

Drug History:

Become of her delayed on set of menarche, she took some herbal & Homeopath medicine for several years from local doctor. But she did not go to a registered physician. Now she takes hematinics & calcium regularly.

General physical Examination:

Appearance – Anxious
Body- Build- below average
Height-104.14cm/3-’5”
Weight – 20 kg
BMI- 17.59
MAC-15cm
Voice-childish
Anemia-Mild
Jaundice-Absent
Oedema-absent
Cyanosis-Absent
Clubbing-Absent
Pulse-98b/min
BP-100/60mm of Hg
Temp-Normal
LN-Not palpable
Thyroid gland-Not enlarged
Gum, Teeth-Normal

Breast Examination:

Breast is well developed and shows normal pregnany changes.

Systemic Examination:

Cardio respiratory system normal.

Musculoskeletal system reveals: Low muscle bulk & bony mass. Muscle power is normal.

Other system reveals: No abnormality

Local Examination:

Per abdominal examination:

Inspection:

Linea nigra, stria gravidarum are present. Umbilicus is everted and centrally placed.

Palpation:

There is a single fetus with cephalic presentation. Head not engaged. Liquor volume seems to be adequate.

Auscultation:

1. FHS not audible
2. But foetal movement present.

Per vaginal Examination:

Restricted

Investigations:

1. Blood grouping and Rh typing- A(+ve)
2. Hb% 9.3 mg/dl
3. Urine R/M/E-Normal
4. RBS-3.8 mmol/L
5. T4-9.82µIU/ml (N=9.32-17.05  µIU/ml)
6. TSH- 3.88 µIU/ml (N=0.27-4.2µIU/ml )
7. USG of pregnancy profile-on 04-06-2013 reveals-single live pregnancy of 34+weeks with cephalic presentation and estimated fetal weight-2470mg

Proposed Investigation:

• CBC
• HBsAg
• VDRL
• Echocardiography
• MRI of Brain
• Growth hormone

Salient Feature of Dwarf Lady With Pregnancy

Mrs Masura, the dwarf lady of 28 years, 2nd  gravida, para-0+1, Muslim, a housewife of the lower class family hailing from Poba, Rajshahi has been admitted in RMCH at her 34 weeks pregnancy. Her menstrual cycle was regular. But she could not accurately mention her LMP she had a regular antenatal check-up. At her first visit in Gynae outpatient department of RMCH, she was diagnosed as a case of a high risk pregnancy.

Thorough investigations were done on that day. USG revealed that single live pregnancy of 8 weeks & EDD on 07-07-2013. The patient was duly immunized. Her bowel and bladder habit is normal. All her family members are in average weight and body built she had no family history of asthma, DM, HTN. The patient had a history of delayed onset of puberty and her age of menarche was at 18 years.

On general examination, Height-3’-5”, wt-20kg, BMI-17.59, MAC-15cm, childish voice, mildly anaemic, oedema, cyanosis, clubbing-absent, pulse-98/min, BP-100/60mmofHg, temperature-normal, LN-not palpable, Thyroid gland-Not enlarged. Breast is well developed and shows normal pregnancy changes, on systemic examination, cardiorespiratory system normal. Musculoskeletal system revels low muscle bolt and bony mass. other systems are normal, per abdominal examination fetal movement was present. FH-corresponds to 34+ weeks.

SFH-30cm grith of abdomen 75cm. There was a single fetus with cephalic presentation. Head was not engaged. Liquor volume seems to be adequate. Her blood group A(+ve), Hb%-9.3 mg/dl, urine R/M/E-Normal, RBS-3.8mmol/ml. USG of pregnancy profile on 04-06-2013-Single live pregnancy of 34+weeks with cephalic presentation and estimated fetal weight-24.70mg.

Diagnosis:

2nd gravida with 34+weeks pregnancy of a dwarf lady (High-risk pregnant lady).

Management:

Treatment Plan:

Elective caesarean section.

Both the Mother and Baby are healthy Now.

PPT Download of Dwarf Lady with Pregnancy:

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Dwarf Lady with Pregnancy

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