Concluded Case

A RARE SEVERE OLIGO HYDRAMNIOS IUD FETAL ASCITES

A 19 years old female, complete anematic, usg report shows a single dead foetus, fetal ascites, hypotensive. O/E BP 80/60 mmHg Pulse 110bpm R/R 24bpm spo2 80% CVS s1 &s2 P Chest B/L clear Abdo. distended Hb% 5.3gm/dl Dx & Rx....????

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Concluded answer
This seems to be Hydrops fetalis only. She is very much anaemic. Go for Hb electrophoresis 1 st, Coagulation profile. Lft Correction of the Anaemia 1st with BTs Then induction of labour with misoprostal tab or Cerviprim gel. Augmentation of labour with oxytocin once she is more than 5 CMS ( dilatation). Proper Antibiotic coverage.
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POSSIBLY OLD I. U. F. D.. ...REMAINED. UNNOTICED
This seems to be Hydrops fetalis only. She is very much anaemic. Go for Hb electrophoresis 1 st, Coagulation profile. Lft Correction of the Anaemia 1st with BTs Then induction of labour with misoprostal tab or Cerviprim gel. Augmentation of labour with oxytocin once she is more than 5 CMS ( dilatation). Proper Antibiotic coverage.
Its already IUD with oligohydramnios with severe anemia .Starting with blood transfusion and maintaining blood pressure recovery of shock. Prepare for delivery of fetus possibly hydrops due to Autoimmunisation or chromosomal abnormality due to viral etiology causing renal failure. Placental abruption also to be ruled out.
Go...for blood transfusion...at the same time attempt for induction of labour with misoprostal/cerviprime/vecredyl.... for fetal expulsion Monitor spo2 ...keep on O2 if required Also be prepared for CS if labour is obstructed Mantain vitals....and post partum complications...
Thanks Dr. Vipin Bihari Jain
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- Go For CBC, BT, CT, SGPT, RFT - Spalding sign is noted in Image , So it is unnoticed old IUFD - Induction with Tab. Mesoprostol 200, 1 tab intra vaginally repeat after 6 to 8 hours depending upon response
Anaemia correction by B.Tranfusion,followed by complete coagulation profile.Induction of labour can be attempted by misoprosr,syntocin drip.LSCS if induction fails.antibiotic cover.
Looking at the current state of the patient, first know its blood and it is common, if it is normal, keep in Mesoprostol 200. Observe after a tab intra crew and 6-8 hours.
Dead faetus 32 wks pregnancy Needs MTP Nearly full term pregnant hence c SECTION may be choice if gen condition of allows Severely anaemic lady will need BT
Thanx dr Pushkar ji Bhomia
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Stabilize the patient with blood transfusion etc and then prepare the patient for foetus expulsion
No LSCS is needed for Iufd unless labour is Obstructed.
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