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RURAL HEALTH MIDWIFE PLACEMENT PROGRAM

MONTHLY CASE STUDY SEPTEMBER 2015

PATIENT’S PROFILE

Client’s Name: Patient XYZ


Age: 31 years old
Occupation: Housekeeper
Marital Status: Married
Husband: Vicente XYZ
Age: 46 years old
Address: Barangay 1, Ilog Negros Occidental

OBSTRETIC HISTORY

MENSTRUAL HISTORY:
Menarche: 12years old
LMP: December 14, 2014
Menstural Cycle: 28 days 3-5 days duration; uses 2-3 pads/day

CURRENT STATUS:
Gravida 4, Para 4
Pre natal checkups: 1st trimester=1
2nd trimester=2
3rd trimester=4
***facility based delivery

Delivered to a live baby boy via normal spontaneous vaginal delivery, cephalic in
presentation.BW=3.2 kg; BL=52cm; AS= 8-9 with good sucking reflex. Placeta out in Schultz
mechanism. Oxytocin injected; 1° laceration noted, sutured by Dr. Ina Marie Rojo. Perineal
care done; Monitored

MEDICATION RECEIVED:
Mother:
Amoxicillin 500mg/cap TID
Mefenamic Acid 500mg/cap TID PRN
Ferrous Sulfate + Folic acid OD
Baby:
Vitamin K
Hepatitis B vaccine
Erythromycin Ophthalmic Ointment
BCG

HEALTH TEACHINGS:
 Instructed to increase fluid , to have post partum check ups
 Explained the importance of newborn screening 48-72 hours for early detection
 Emphasized the value of immunization for early prevention of childhood illnesses
 Encouraged regular breastfeeding and discussed the benefits of it
 Discussed the importance of family planning.

CLINICAL DISCUSSION

Placenta Accreta is a serious pregnancy condition that occurs when blood vessels and other
parts of the placenta grow too deeply into the uterine wall. Typically, the placenta detaches
from the uterine wall after childbirth. With placenta accreta, part or the entire placenta
remains firmly attached. This can cause severe blood loss after delivery. It’s also possible for
the placenta to invade the muscles of the uterus (placenta increta) or grow through the
uterine wall (placenta percreta).
Placenta accreta is considered a high-risk pregnancy complication. If placenta accreta is
suspected during pregnancy, you'll likely need an early C-section delivery followed by the
surgical removal of your uterus (hysterectomy).

Symptoms:
Placenta accreta often causes no signs or symptoms during pregnancy — although vaginal
bleeding during the third trimester is possible. Often, placenta accreta is detected during a
routine ultrasound.
Many factors can increase the risk of placenta accreta, including:

 Previous uterine surgery. If you've had a C-section or other uterine surgery, you're at
increased risk of placenta accreta. The risk of placenta accreta increases with the number
of uterine surgeries.
 Placenta position. If your placenta partially or totally covers your cervix (placenta previa)
or sits in the lower portion of your uterus, you're at increased risk of placenta accreta.
 Maternal age. Placenta accreta is more common in women older than 35.
 Previous childbirth. The risk of placenta accreta increases each time you give birth.
 Uterine conditions. The risk of placenta accreta is higher if you have abnormalities or
scarring in the tissue that lines your uterus (endometrium). Noncancerous uterine growths
that bulge into the uterine cavity (submucosal uterine fibroids) also increase the risk.

Submitted by:

RIZALIE G. ESTOCHE, RM
RHMPP

Noted by:

INA MARIE R. ROJO, MD


OIC-MHO

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