Gulshan Ara Saeed.
A 52 year old lady presenting with Pregnancy and Anemia.
Pak Armed Forces Med J Jan ;52(2):223-4.

A 52 year old gravida 12 para 8 abortions 3, last child born 3 years back was admitted on her first antenatal visit at 37 weeks of pregnancy with complaints of dyspnea and headache for one week. Her history revealed that present pregnancy was un-eventful until now with no prior antenatal visits. All previous deliveries were at home. On examination she had a blood pressure of 140/90 mm of Hg, Palor positive, with slight pedal oedema. Abdominal examination showed a symphisio-fundal height corresponding to gestational age with a single fetus in a longitudinal lie and cephalic presentation. She was investigated for her anemia (Blood group A +ve, Hb:9.0 gm/dl, HCT:26.3%, MCV:77.4 fl, MCH:26.8 pg, MCHC:33.7 gm/dl, with a microcytic hypochromic red cell morphology, Serum iron 55 mcgm/dl and Serum TIBC: 390mcgm/dl). Blood sugars and renal function tests were normal. Abdominal ultrasonography revealed (Single active fetus, Femur length : 7.2cm, Biparietal diameter :9.Ocm, Liqour adequate, Placenta upper-anterior, biophysical profile 10/10). On admission she was given total dose iron infusion (Venofer) and blood was cross-matched. Her symptoms improved with treatment and rest over the next week. At 39 weeks + 2 days she went into spontaneous labor. Maternal and fetal monitoring was performed and plotted on partogram. Labor lasted for 3 hours and 30 minutes (first stage:3 hours, second stage: 25 minutes and third stage 5 minutes). Active management of third stage of labor was done and blood loss was limited to around 150ml. Outcome was an alive and healthy male baby, weight :2.5kg with Apgar score of 8/10 and 10/10, handed over to peadiatrician for evaluation of any abnormality. First post natal day ligation was done after couple counseling and consent. The mother and the baby were discharged on second post-natal day in satisfactory health.

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