27yr/f second gravida,EDD 6/8/16 C/O : fever c chills,burning micturation,productive cough,coryza,nausea since 2days.BG: B+ve Father's BG :N/A 1st was FTND TPC was 11k 14 units of BT at the time of her 1st delivery Following examination are attached.. Valueble opinions plz...



Start Injectiin Monecef 1gm iv BD Arrange for 1 unit BT Also start inj Iron and folic acid For coryza and cough syp Brozedex Syp Alkamax MB6 in water BD Tab Pyridium for burning micturition If No bleeding from any site observe platelates ,Nothing to worry Tab Wysolon 20 BD for 5 days can be given safly .

37weeks completed,case of ITP,r/o hepatosplenomegaly,no megaly,then a case of I TP confirmed with severe anemia with acute pyelonephritis send blood c/s,urine c/s,LFT,LDH,coagulation profile,xray chest with abd shield,KFT,uric acid,RBS start her on fresh blood transfusion,IV antibiotics magnex forte 1.5 GM IV bd ,manage labour electively,arrange SDP,uterine packing after delivery,800 1200mcg of meso,continuos IV infusion of syntocinon for at least 8 hrs,trgt platelet count 50k,she may go fr sec pph,be care ful,only transfusions is treatment,with upgrading of anti biotics to meropenem,and clindamycin

it is case of uti n anemia.do a urine culture.aftr taking sample start on inj.taxim 1gm iv bd ATD.after she settles down wit the uti gv her orofer injections in 100 ml NS ATD fr her anemia n iron rich foods

get her urine c/ s done. meanwhile start tab augmentin 625mg tds,one other symptomatic treatment. Regarding anaemia give her blood transfusion when her fever subside.

Mam what about TPC?

Hb, MCH, MCHC is low. suspect iron deficiency anemia. test for s.ferritin if <12microgm/L its IDA. ELISA for dengue. even LRI will produce fever with chills. since transfusion history is long back can do HBsAg .

u should rule out cause of fever first... see pt hv h/o BT... do dengue test... and jaundice.... see has thrombocytopenia so kindly rule out cause of thrombocytopenia.. kindly do coagulation profile

Dengue done report attached, No ictrus/palor nor active bleeding

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Do urine C/S., R/o chest infection... with 2 days of fever can't expect the widal and NS1 antigen to be positive; rpt NS1 after 5 days of fever .... and wat was the cause for so many BT during 1st delivery traumatic PPH or Atonic? ?? ...reg gestational thrombocytopenia usually doesn't go below 80k; do thorough coagulation profile and LFT,RFT..

regarding fever in pregnancy case get peripheral smear opinion. RS -- Examination ( cough). as someone suggested antibiotics n urine culture. SOS X-ray chest with shielding. physician involvement will definitely helpful in treating patient as well medicolegally

Treat her cystitis with amoxclav 625 bd, give antacids along till then work up other investigation s to rule out thrombocytopenia.refer to tertiary care from delivery.

As valuable opinions from all clinicians , also see if any leaking PV or any local cause of vaginal discharge , could also be cause of fever .take a HVS sample and get it reported .

Mam no leaking
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