The patient is a 19 year old female, G3P2, admitted for labor pains at 38 weeks gestation. She has a history of two previous cesarean sections. On examination, she is in active labor with adequate amniotic fluid volume and a cephalic fetal presentation. Ultrasound shows a live intrauterine pregnancy estimated at 30 weeks and 5 days. She is scheduled for an elective lower segment cesarean section under antibiotic prophylaxis.

1. TAHBSO
 CASE PRESENTATION
 MUKESH SAH, MD
 POST-GRADUATE MEDICAL INTERN
 GOODSAM MEDICAL CENTER

2. CASE
VG
41/Married
Roman Catholic
CAB CITY, NUEVA ECIJA
Unemployed
Admitted 8/24/2018

3. Chief complaint
Pelvo-abdominal mass

4. History of Present Illness
 1 year PTA, patient noticed an
enlarging abdomen, no consult was
done.
 1 month PTA, (+) Vaginal bleeding with
pain associated with enlarging
abdomen consult at R1MC and was
scheduled for elective OR
 1 day PTA, patient was admitted for the
said operation.

5. Past medical History
Unremarkable
Family History
No noted heredofamilial diseases
Personal & Social History
Unremarkable
Immunization
None

6. Gynecological Hx
Menarche- 12 y/o
Interval- Regular
Duration- 6-7 days
Amount- 3-4 pads/day
Symptoms- (-) dysmenorrhea
Coitus - 19 y/o
No. of partner- 1

7. LMP: August 19, 2018
G2P2(2002)
G1- 1999, NSD, R1MC, live Girl
G2- 2003, NSD, R1MC, live Girl

8. Physical Examination
Patient is conscious, coherent not in cardio
respiratory distress
BP:100/80mmHg CR:88bpm RR:21 T:36.4C
Skin: (+)pallor (-) jaundice (-) cyanosis
Head EENT: Anicteric sclerae, pale palpebral
conjuntiva
Chest and Lungs: Symmetrical chest expansion, no
retractions, no lagging, clear breath sounds
Cardiovascular: Adynamic precordium, normal
rate regular rhythm, no murmur

9. Physical Examination
Flabby abdomen, (+) palpable hypogastric mass
measuring about 21 x 19cm, solid, slightly mobile,
nontender.
External genitalia grossly normal;
IE: Cervix admits tip, midline; uterus small, regular,
firm, movable, + left adnexal mass measuring 21x
19cm, solid, slightly mobile, nontender, right adnexa
free, with scanty vaginal bleeding.

16. Day 1 of Admission
 8- 24-2018
 Admitted at Gyne ward
 GL then NPO
 Secure 2 units of PRBC properly typed and
crossmatched for possible OR use
 For elective EHBSO, BLND, PFC, IO

17. Operation done
 Resection of the Ovarian malignancy
 EHBSO
 BLND
 IO

19. Operative Findings
On laparotomy, no hemoperitoneum with
100cc ascites noted. The left ovary was enlarged to
about 20x20cm, solid adherent to omentum, intestines
and left pelvic wall. The right ovary was enlarged to
about 6x5cm, cystic. The uterus was tan in color,
irregular in shape.
Then proceeded to Resection of left ovary,
EHBSO, BLND and IO .
On cut section, the left ovary has solid and
fleshy component, right ovary has brownish fluid and
some solid areas. The uterus has a 1x1cm mass
embedded within the myometrium with whorled like
pattern.

20. Final Diagnosis
G2P2(2002) Ovarian new growth
malignant, stage IIC
Pelvic adhesions

21. CASE 2
VD
51yo/Married
Roman Catholic
CABANATUAN CITY
Unemployed
Admitted 08/27/2018

22. Chief complaint
 Vaginal bleeding

23. History of Present Illness
 2 months PTA, patient experienced
prolonged vaginal bleeding for 2weeks
consuming 4 – 5 pads per day, moderately
soked with no associated hypogastric pain,
no medications taken nor consultation
sought.
 One month prior to admission, symptoms
persisted which prompted consult to R1MC
hence, workup done and scheduled for
elective OR.

24. Past medical History
Unremarkable
Family History
+DM- mother
Personal & Social History
Unremarkable

25. Gynecological Hx
Menarche- 13 y/o
Interval- Regular
Duration- 7 days
Amount- 4-5 pads/day
Symptoms- (+) dysmenorrhea
Sexual history
First coitus: 25 y/o
No. of partner- 1

26. OB Hx
 LMP- August 15, 2018
 G9P7(7027)
 G1 – 1989, NSD, HD, Live Girl
 G2 - 1991, NSD, HD, Live Girl
 G3 – 1995Jan, NSD, HD, Live Boy
 G4 – 1995Nov, NSD, HD, Live Boy
 G5 - 2000, NSD, HD, Live Girl
 G6 – 2003, Abortion
 G7 – 2004, Abortion
 G8 - 2005, NSD, HD, Live Girl
 G9- 2006, NSD, HD, Live Boy

27. Physical Examination
Patient is conscious, coherent not in cardio respiratory
distress
BP:120/90mmHg CR:86 bpm RR:19 T:36.5C
Skin: (-) pallor (-) jaundice (-) cyanosis
HEENT: Pink palpebral conjuntiva, Anicteric Sclerae
Chest and Lungs: Symmetrical chest expansion, no
retractions, clear breath sounds
Cardiovascular: Adynamic precordium, normal rate
regular rhythm, no murmur

28. Physical Examination
Abdomen is flabby, soft, +palpable mass
about 14 x 11cm firm, irregular in size,
mobile, nontender.
IE- Normal external genitalia,
Cervix open with prolapsing mass about
4x3cm, firm, +pedicle 2x1cm seemingly
attached to the posterior isthmus
associated with scanty bleeding. Uterus is
enlarged to 14 x 11cm firm, irregular in size,
mobile, nontender, both adnexa free.

29. Admitting Diagnosis
G9P7(7027) AUB-L

30. Day 1 of Admission
 8-27-2018
 Admitted at Gyne ward
 GL then NPO postmidnight
 Secure 2 units of PRBC properly typed and
crossmatched
 For emergency TAHBSO

34. Operative Findings
On laparotomy, no hemoperitoneum nor ascites noted,
smooth, pinkish uterus seen about 3 months size, irregular in
shape.. Both ovaries and fallopian tubes were grossly normal, then
proceeded to TAHBSO.
Grossly, the uterus measures 14 x 12 x 7cms,
asymmetrically enlarged, left fallopian tube 7 x 0.5 cm and right
fallopian tube 8 x 0.5 cm and were grossly normal. Cervix is whitish
smooth measuring 5x4x3 cm.
On cut section, uterus has blot hemorrhages within the
myometrium. A 4 x 4cm mass located at cervical area with
pedicle attached to the posterior isthmus having whorled like
pattern. Anterior myometrium is 4 cm thick and Endometrial canal
measures 8cm. Cervical canal measures 4.5cm.

37. Final Diagnosis
G9P7(7027) AUB- A,L

38. CASE 3
BR
43y/o/Married
Roman Catholic
NUEVA ECIJA
Unemployed
Admitted 7-28-18

39. Chief complaint
Vaginal Bleeding with pain
 Pelvoabdominal mass

40. History of Present Illness
 1 year PTA, patient noticed an enlarging
abdomen, no consult was done.
 1 month PTA, (+) Vaginal bleeding with pain
associated with enlarging abdomen
consult at R1MC and was scheduled for
elective
 5 days PTA, persistence of bleeding
consuming 3 diaper pads/day associated
with hypogastric pain, consulted at R1MC
and was admitted.

41. Past medical History
Unremarkable
Family History
(+) HPN mother, No other
heredofamlial diseases noted
Personal & Social History
Unremarkable
Immunization- none

42. OB Hx
Menarche-15y/o
Interval- Regular
Duration- 3 days
Amount- 2 pads/day
Symptoms- (-) dysmenorrhea
Coitus- 18yo
No. of partner- 1

43. LMP: June last week 2018
G1P1 (1001)
G1- 1994, term, NSD, hospital delivery, female, Alive

44. Physical Examination
Patient is conscious, coherent not in cardio
respiratory distress
BP:140/80mmHg CR:83bpm RR:19 T:36.6C
Skin: (-)pallor (-) jaundice (-) cyanosis
Head EENT: Anicteric sclerae, pale palpebral
conjuntiva
Chest and Lungs: Symmetrical chest expansion, no
retractions, clear breath sounds
Cardiovascular: Adynamic precordium, normal
rate regular rhythm, no murmur

45. Physical Examination
Globular abdomen, soft, normoactive bowel sounds,
soft, non-tender with 2 palpable masses at
hypogastric area measuring about 12x10cm, firm,
irregular in shape, slightly mobile, nontender and 12 x
15cm cystic mass, mobile,nontender.
IE- Normal external genitalia,
Cervix admits tip, midline
Uterus enlarged about 12x10cm, firm, irregular in
shape, slightly mobile, nontender, right adnexa with
cystic mass about 12 x 15cm, mobile, nontender, left
Adnexa free, with minimal vaginal bleeding.

46. Admitting Diagnosis
G1P1 (1001) AUB-L; Anemia
severe secondary to chronic
blood loss; ONG, right

47. Day 1 of Admission
 DAT
 Secure 3 units PRBC then to transfuse
 Tranexamic acid 1g IV q 8
On 3rd HD
 For emergency TAHBSO

59. Operative Findings
On laparotomy, no hemoperitoneum nor ascites noted, smooth,
pinkish uterus seen about 3 months size, irregular in shape,
adherent to right ovary, omentum and rectosigmoid area,
enterolysis was done. The right ovary was cystically enlarged
adherent to the omentum and posterior wall of uterus, Adhesiolysis
was done, then proceeded to TAHBSO.
Grossly, the uterus measures 12 x 10 x 10cms,
asymmetrically enlarged, left fallopian tube 7 x 0.5 cm and right
fallopian tube 10 x 0.5 cm and were grossly normal. The right ovary
measures 11x 15cm, cystic with chocolate-like fluid, left ovary
measures 2x2cm, grossly normal. Cervix is whitish smooth
measuring 4x3x3 cm.
On cut section, uterus has thick myometrium having
interspered blot hemorrhages.Anterior myometrium is 3 cm thick
with endometrial canal 7 cm. The right ovary was cystic, thin
walled with chocolate like fluid.

64. Final Diagnosis
G1P1 (1001) Adenomyosis , Pelvic
Endometriosis, endometrioma right
ruptured

65. CASE 3
CK
19y/o/Single
Roman Catholic
CABANATUAN CITY
Unemployed
Admitted 6-20-18

66. Chief complaint
Labor pains

67. History of Present Illness
Few hrs pta patient
experienced hypogastric pain,
no bleeding, no watery
vaginal discharge. Progression
of pain prompted consult
hence, admission

68. Past medical History
Unremarkable
Family History
unremarkable
Personal & Social History
Unremarkable
Immunization- TT 3 doses

69. OB Hx
Menarche-12y/o
Interval- Regular
Duration- 5 days
Amount- 3 pads/day
Symptoms- (-) dysmenorrhea
Sexual hx- 14yo
No. of partner- 1

70. LMP: September 25, 2017
G3P2 (2002)
G1- 2014, term, CS, hopital delivery, girl, Alive
G2- 2016, term, CS, hospital delivery, girl, Alive
G3- present pregnancy

71. Physical Examination
Patient is conscious, coherent not in cardio
respiratory distress
BP:100/70mmHg CR:68bpm RR:20 T:36.3C
Skin: (-)pallor (-) jaundice (-) cyanosis
Head EENT: Anicteric sclerae, pink palpebral
conjuntiva
Chest and Lungs: Symmetrical chest expansion, no
retractions, clear breath sounds
Cardiovascular: Adynamic precordium, normal
rate regular rhythm, no murmur

72. Physical Examination
globular abdomen, FH 25cms
External genitalia grossly normal;
IE: admits tip

73. Admitting Diagnosis
G3P2 (2002) PU 38 2/7 weeks
AOG, cephalic in labor,
previous CS 2x (2014, UDH,
malpresentation) (2016, UDH);
teenage pregnancy

74. Day 1 of Admission
 Admitted at LR-DR
 Secure consent
 Diagnostics
- CBC typing
- HBsAg
- VDRL
- UA
 Therapeutics
- PLRS 1L x 30 gtts/min
- Schedule for ‘E’ LTCS III
- Secure consent
- Notify OR/ROD/Pedia
- Cefuroxime 1.5g IV (-) ANSTprior to OR then 750mg IV q8*

75. Day 1 of Admission
 Admitted at LR-DR
 Secure consent
 Diagnostics
- CBC typing
- HBsAg
- VDRL
- UA
 Therapeutics
- PLRS 1L x 30 gtts/min
- Schedule for ‘E’ LTCS III
- Secure consent
- Notify OR/ROD/Pedia
- Cefuroxime 1.5g IV (-) ANSTprior to OR then 750mg IV q8*
 Monitor VS, FHT q1*

76. Ultrasound findings: (5/14/18)
 There is a single live, intrauterine pregnancy in cephalic presentation
with active cardiac pulsation of 142 beats per minute and good
somatic motion by real time scan. BPD, AC and FL are compatible
wit 30 weeks 5 days AOG. Placenta is posterior in location, grade II
maturity. No evidence of placenta previa, subplacental
hemorrhage, or separation seen amniotic fluid volume is adequate
for the trimester with an AFI of 9.0cm.
 Impression: SINGLE, LIVE, INTRAUTERINE PREGNANCY IN CEPHALIC
PRESENTATION, 30 WEEKS 5 DAYS AOG BY FETAL BIOMETRY, MODIFIED
BPS OF 8/8, POSTERIOR PLACENTA, GRADE II MATURITY,
NORMOHYDRAMNIOS
EBD: 7/18/18 (+/-2 WEEKS)
PRESENT EFW: 1.55 KG
BABY GIRL

77. Day 1 of Admission
Blood type- O positive
CBC typing (6-14-18)
Parameter Result Parameter Result
WBC 12.44x 10/L MCV 90.5 f/L
Neutrophils 73% MCH 29.5 pg
Lymphocytes 17.7% MCHC 326g/L
Monocytes 6.3% RDW-CV 12.7 %
Eosinophils 2.6% RDW-SD 46.9 f/L
Basophils 0.4% PLT 242 x 10/L
Rbc 3.49 x 10/L MPV 8.4f/L
Hgb 103g/L PDW 16.3
Hct 31.6 % PCT 0.20%

78. Operative Findings

79. Final Diagnosis
 G3P3 (3003) PU term cephalic delivered via LTCS
III with IUD insertion with scarred uterus under SAB
a live baby girl BW 2590g BL 48cms AS 8,9 BS 39
AGA, previous LTCS 2x (2014, 2016, UDH); Post op
ahesions, Family Planning Acceptor (IUD)

80. CASE 4
LM
21y/o/Single
Roman Catholic
NUEVA ECIJA
Unemployed
Admitted 6-20-18

81. Chief complaint
Labor pains

82. History of Present Illness
Few hrs pta patient
experienced hypogastric pain,
no bleeding, no watery
vaginal discharge. Progression
of pain prompted consult
hence, admission

83. Past medical History
Unremarkable
Family History
unremarkable
Personal & Social History
Unremarkable
Immunization- TT 2 doses

84. OB Hx
Menarche-12y/o
Interval- Regular
Duration- 5 days
Amount- 3 pads/day
Symptoms- (-) dysmenorrhea
Sexual hx- 14yo
No. of partner- 1

85. LMP:
G2P2 (2002)
G1- 2014, term, CS, hopital delivery, girl, Alive
G2- present

86. Physical Examination
Patient is conscious, coherent not in cardio
respiratory distress
BP:/mmHg CR:bpm RR: T:C
Skin: (-)pallor (-) jaundice (-) cyanosis
Head EENT: Anicteric sclerae, pink palpebral
conjuntiva
Chest and Lungs: Symmetrical chest expansion, no
retractions, clear breath sounds
Cardiovascular: Adynamic precordium, normal
rate regular rhythm, no murmur

87. Physical Examination
globular abdomen, FH cms
External genitalia grossly normal;
IE: admits tip

88. Admitting Diagnosis
G2P2 (2002) PU weeks AOG,
cephalic in labor,

89. Day 1 of Admission
 Admitted at LR-DR
 Secure consent
 Diagnostics
- CBC typing
- HBsAg
- VDRL
- UA
 Therapeutics
- Cefuroxime 1.5g IV (-) ANSTprior to OR then 750mg IV
q8*

90. Day 1 of Admission
 Admitted at LR-DR
 Secure consent
 Diagnostics
- CBC typing
- HBsAg
- VDRL
- UA
 Therapeutics
- Secure consent
- Notify OR/ROD/Pedia
- Cefuroxime 1.5g IV (-) ANSTprior to OR then 750mg IV q8*
 Monitor VS, FHT q1*

91. Ultrasound findings:

92. Day 1 of Admission
Blood type- O positive
CBC typing (6-14-18)
Parameter Result Parameter Result
WBC x 10/L MCV 90.5 f/L
Neutrophils % MCH 29.5 pg
Lymphocytes % MCHC 326g/L
Monocytes % RDW-CV 12.7 %
Eosinophils % RDW-SD 46.9 f/L
Basophils % PLT x 10/L
Rbc x 10/L MPV 8.4f/L
Hgb g/L PDW 16.3
Hct % PCT 0.20%

93. Operative Findings

94. CASE 5
EC
23y/o/Single
Roman Catholic
CABANATUAN CITY
Unemployed
Admitted 6-21-18

95. Chief complaint
Labor pains

96. History of Present Illness
 12 hrs pta, patient
experienced hypogastric pain,
no bleeding, no watery
vaginal discharge. Progression
of pain prompted consult
hence, admission

97. Past medical History
Unremarkable
Family History
unremarkable
Personal & Social History
Unremarkable
Immunization- TT 1 dose

98. OB Hx
Menarche-13y/o
Interval- Regular
Duration- 3-4 days
Amount- 6 pads/day
Symptoms- (+) dysmenorrhea
Sexual hx- 18yo
No. of partner- 1

99. LMP: Sept. 14, 2017
G2P1 (1001)
G1- 2016, term, NSD, hospital delivery, girl, Alive
G2- present

100. Physical Examination
Patient is conscious, coherent not in cardio
respiratory distress
BP: 110/70 mmHg CR: 86 bpm RR: 21 T: 36.5C
Skin: (-)pallor (-) jaundice (-) cyanosis
Head EENT: Anicteric sclerae, pink palpebral
conjuntiva
Chest and Lungs: Symmetrical chest expansion, no
retractions, clear breath sounds
Cardiovascular: Adynamic precordium, normal
rate regular rhythm, no murmur

101. Physical Examination
globular abdomen, FH 33 cms
External genitalia grossly normal;
IE: 5-6 cms
50% effaced
Station -3
(+) BOW
(-) Show

102. Admitting Diagnosis
G2P1 (1001) PU 39 6/7 weeks
AOG, cephalic in labor,
hyperthyroidism

103. Day 1 of Admission
 Admitted at LR-DR
 Secure consent
 Diagnostics
- CBC typing
- HBsAg
- VDRL
- UA
 Therapeutics
- D5LRs 1L x 30 gtts/min
- Incorporate 8 units of oxytocin to run at 10 gtts/min
- Monitor VS, FHT q1*

104. Day 1 of Admission
 Admitted at LR-DR
 Secure consent
 Diagnostics
- CBC typing
- HBsAg
- VDRL
- UA
 Therapeutics
- Secure consent
- Notify OR/ROD/Pedia
- Cefuroxime 1.5g IV (-) ANSTprior to OR then 750mg IV q8*
 Monitor VS, FHT q1*

105. Ultrasound findings:

106. Day 1 of Admission
Blood type- O positive
CBC typing (6-14-18)
Parameter Result Parameter Result
WBC x 10/L MCV 90.5 f/L
Neutrophils % MCH 29.5 pg
Lymphocytes % MCHC 326g/L
Monocytes % RDW-CV 12.7 %
Eosinophils % RDW-SD 46.9 f/L
Basophils % PLT x 10/L
Rbc x 10/L MPV 8.4f/L
Hgb g/L PDW 16.3
Hct % PCT 0.20%

107. Operative Findings

108. Gyne
Post-op

109. CASE 1
GF
62 yo/Married
RC
CABANATUAN CITY
Unemployed
June 20, 2018

110. Chief complaint
Pelvo-abdominal mass

111. History of Present Illness
3 years pta, patient noted a
gradually enlarging pelvic mass, no
vaginal bleeding was noted,
nontender. Patient sought consult at a
private clinic and was advised for
observation.
Until, 1 month pta, enlarging mass
persisted, hence consult at our
institution, scheduled for elective OR.

112. Past medical History
Unremarkable
Family History
+ Hypertension +DM- mother
Personal & Social History
Unremarkable
Immunization- none

113. Gynecological Hx
Menarche-15y/o
Interval- Regular
Duration- 3-5 days
Amount- 3 pads/day
Symptoms- (-) dysmenorrhea
Sexual hx- 19yo
No. of partner- 1

114. Menopause: 54yo
G2P2 (2002)
G1- 1976, NSD, term, , Male, Alive
G2- 1979, NSD, term, , Male, Alive

115. Physical Examination
Patient is conscious, coherent not in cardio
respiratory distress
BP:120/80mmHg CR:80bpm RR:20 T:36.4C
Skin: (-)pallor (-) jaundice (-) cyanosis
Head EENT: Anicteric sclerae, pink palpebral
conjuntiva
Chest and Lungs: Symmetrical chest expansion, no
retractions, no lagging, clear breath sounds
Cardiovascular: Adynamic precordium, normal
rate regular rhythm, no murmur

116. Physical Examination
Abdomen flabby, soft, (+) palpable hypogastric
mass, firm, mobile, nontender measuring about
15x10cm.
External genitalia grossly normal;
IE: Cervix closed, midline, uterus enlarged to 4months
size, firm, mobile, nontender, adnexa free, no vaginal
bleeding.

117. Admitting Diagnosis
G2P2 (2002) Myoma uteri

118. Day 1 of Admission
 6-20-18
 Admitted at Gyne ward
 NPO
 Secure 2 units of PRBC properly typed and
crossmatched
 For elective OR in am(TAHBSO), secure consent
 Meds: Cefuroxime, Metronidazole, Bisacodyl
 Do fleet enema
 Secure 2 units PRBC

119. Day 1 of Admission
Blood type- B positive
CBC typing (6-26-18)
Parameter Result Parameter Result
WBC 20.9810/L MCV 87.4 f/L
Neutrophils 89.3% MCH 28.3 pg
Lymphocytes 7.2% MCHC 324g/L
Monocytes 3.3% RDW-CV 13.0 %
Eosinophils 2.9% RDW-SD 41.7 f/L
Basophils 0.4% PLT 239 x 10/L
Rbc 5.0 x 10/L MPV 9.4 f/L
Hbg 143 g/L PDW 9.3
Hct 0.43 % PCT 0.280%

120.  Sodium 142
 Potassium 4.37
 Chloride 108.7
 Ionized calcium 1.24
 Urea 4.5
 Crea 86
 FBS 10.4

121. Operation done
 TAHBSO

122. Operative Findings
 On laparotomy, no hemoperitoneum nor ascites
noted. The uterus was enlarged to 4 months size, irregular
in shape. Both ovaries and fallopian tubes were grossly
normal. Then proceeded to TAHBSO.
 Grossly the uterus 15 x 11x 8cm, left ovary measures 2x2cm
and left fallopian tube 6x 0.5cm. Right ovary measures
2x2cm and right fallopian tube measures 7x 0.5cm. Cervix
is whitish smooth measuring 4x 3x 3cm.
 On cut section, uterus was smooth in surface, anterior
myometrium is 1.5cm and Endometrial canal of 10cm.
Single mass was seen within the myometrium measuring
14xv10cm with whorled like pattern.

123. Final Diagnosis
G2P2 (2002) Myoma uteri
S/p appendectomy (2015, R1MC)

124. CASE 2
AE
58/Married
Roman Catholic
Urbiztondo, Pangasinan
Unemployed
Admitted 6/20/18

125. Chief complaint
 vaginal mass

126. History of Present Illness
 1 year ptc, patient noted, non tender
vaginal mass which started to grow slowly.
Mass noted to be reducible, non tender,
without discharge nor bleeding.

127. Past medical History
Unremarkable
Family History
+ hypertension
Personal & Social History
Unremarkable
Immunization
None

128. Gynecological Hx
Menarche- 13 y/o
Interval- Regular
Duration- 3 days
Amount- 4-5pads/day
Symptoms- (-) dysmenorrhea
Sexual hx- 19 y/o
No. of partner- 1

129. OB Hx
 G6P6 (6006)
 G1 -1980, term, NSD, home,female
 G2 -1982, term, NSD, home, male
 G3- 1983, term, NSD, home,female
 G4-1986, term, NSD, home,female
 G51-1988, term, NSD, Manila,female
 G6- 1993, term, NSD, Manila,female

130. Physical Examination
Patient is conscious, coherent not in cardio respiratory
distress
BP:/mmHg CR84 bpm RR:18 T:36.5C
Skin: (+)pallor (-) jaundice (-) cyanosis
Head EENT: Anicteric sclerae, pink palpebral
conjuntiva
Chest and Lungs: Symmetrical chest expansion, no
retractions, clear breath sounds
Cardiovascular: Adynamic precordium, normal rate
regular rhythm, no murmur

131. Physical Examination
Abdomen is globular, soft, non-tender
IE- Normal external genitalia,
Cervix, midline uterus small. Prolapsed 3
cm beyond hymenal

132. Admitting Diagnosis
G6P6(6006)

133. Day 1 of Admission
 6-20-18
 Admitted at Gyne ward
 NPO past midnight
 Secure 2 units of PRBC properly typed and
crossmatched
 For Elective TAHBSO

134. Day 1 of Admission
Blood type- positive
CBC typing (6-5-18)
Parameter Result Parameter Result
WBC 6.96x 10/L MCV 90.9 f/L
Neutrophils 62.7% MCH 29.4 pg
Lymphocytes 32.6% MCHC 323g/L
Monocytes 4.3% RDW-CV 15.3 %
Eosinophils 6.0% RDW-SD 50.8 f/L
Basophils 0.3% PLT 382x 10/L
Rbc 6.4 x 10/L MPV 9.2 f/L
Hbg 135g/L PDW 9.4
Hct 0.33 % PCT 0.580%

135.  Sodium 139
 Potassium 4.21
 Chloride 11.2
 Ionized calcium 1.21
 FBS 5.8

136. Operative Findings

137. CASE 3
PL
46/Married
Roman Catholic
CABANATUAN CITY
Unemployed
Admitted 6/20/18

138. Chief complaint
 Enlarging abdomen

139. History of Present Illness
 6 months prior to admission, patient noted
gradually enlarging abdomen, no consult
done.
 2 months pta, persistence of above
symptoms now with difficulty of urination
sought consult at our instituiton and was
requested with ultrasound which revelaed
myoma uteri and was then later on
scheduled for OR.

140. Past medical History
Unremarkable
Family History
+ hypertension (maternal and paternal
side)
+ TB
Personal & Social History
Unremarkable
Immunization
None

141. Gynecological Hx
Menarche- 12 y/o
Interval- Regular
Duration- 3 days
Amount- 4-5pads/day
Symptoms- (-) dysmenorrhea
Sexual hx- 15 y/o
No. of partner- 1

142. OB Hx
G4P4 (4004)
 G1 -1990, term, NSD, home,female
 G2 -1992, term, NSD, home, male
 G3- 1994, term, NSD, home,female
 G4-1995, term, NSD, home,female

143. Physical Examination
Patient is conscious, coherent not in cardio respiratory
distress
BP:110/80mmHg CR84 bpm RR:18 T:36.5C
Skin: (+)pallor (-) jaundice (-) cyanosis
Head EENT: Anicteric sclerae, pink palpebral
conjuntiva
Chest and Lungs: Symmetrical chest expansion, no
retractions, clear breath sounds
Cardiovascular: Adynamic precordium, normal rate
regular rhythm, no murmur

144. Physical Examination
Abdomen is globular, soft, non-tender
with palpable mass about 20x15cm,
firm, mobile, nontender
IE- Normal external genitalia,
Cervix, midline uterus enlarged to
5months size, irregular, firm, mobile,
nontender, adnexa free, no bleeding.

145. Admitting Diagnosis
G4P4(4004)Myoma uteri
Hydronephrosis, right

146. Day 1 of Admission
 6-20-18
 Admitted at Gyne ward
 NPO past midnight
 Secure 2 units of PRBC properly typed and
crossmatched
 For Elective TAHBSO with Stenting

147. Day 1 of Admission
Blood type- positive
CBC typing (6-5-18)
Parameter Result Parameter Result
WBC 12.55x 10/L MCV 90.9 f/L
Neutrophils 88.3% MCH 29.4 pg
Lymphocytes 10.7% MCHC 323g/L
Monocytes 0.9% RDW-CV 15.3 %
Eosinophils 6.0% RDW-SD 50.8 f/L
Basophils 0.2% PLT 260x 10/L
Rbc 0.1 x 10/L MPV 9.2 f/L
Hbg 137g/L PDW 9.4
Hct 0.33 % PCT 0.580%

148.  Sodium 140.3
 Potassium 427
 Chloride 108
 Ionized calcium 1.21
 FBS 5.3

149. Operative Findings
 On laparotomy, no hemoperitoneum nor ascites
noted. The uterus was enlarged to 5 months size,
irregular in shape. Both ovaries and fallopian tubes
were grossly normal. Then proceeded to TAHBSO.
 Grossly the uterus 21x 16x 11cm, left ovary measures
2x2cm and left fallopian tube 8x 0.5cm. Right ovary
measures 2x2cm and right fallopian tube measures
7x 0.5cm. Cervix is whitish smooth measuring 6x 4x
3cm.
 On cut section, uterus was smooth in surface,
anterior myometrium is 2cm and Endometrial canal
of 19cm. Single mass was seen within the
myometrium measuring 13x 15cm with whorled like
pattern.

152. Final Diagnosis
G4P4(4004)Myoma uteri-
Intramural