Ward : 1BBed : 24 RN : 1311697
Name : Armawati Bt Mohd Asrar
Age : 34
Gender : Female
Race : Malay
Religion : Islam
Address : Bukit Tinggi, Klang
Occupation : Account Executive
Gravida : 3
Para : 2
Period of Amenorrhea : 39 weeks
Date of Admission : 24 October 2012
Date of Examination : 24 October 2012
Last Menstrual Period : 25 January 2012
Expected Due Date : 1 November 2012
Patient complain of severe colicky pain starting at the suprapubic region radiating to the back, since 2:15am on 24 October 2012 until present .
History of Presenting Illness
Past Obstetrics History
This is her third pregnancy. She have 2 daughters aged 4 and 8 years old respectively , who were delivered by normal induced vaginal delivery. Her first child was delivered 20 days earlier than her EDD and the birth weight was 2.7Kg. As for her second child, she delivered by full term and the birth weight was 3.1Kg. She breastfeed both of her daughters for four whole years. Her daughters are now alive and well.
Past Menstrual History
Since menarche at 13 yrs old, her menses had been regular of 28 - 30 days cycle with normal flow for 7-10 days . Averagely, she used 2 pads per day. No history of dysmenorrhea, clotting and flooding.
Past Gynaecology History
She has taken oral contraceptive pill for her family planning. The couple wishes to have children every four years. Apart from that, She also had pap smear done in 2004 and 2008. There were no abnormalities detected. There are also no history of surgical procedure , infertility and STI.
Past Medical History
No relevant medical history.
Past Surgical History
No surgical procedure
During Pregnancy , she took several supplements such as Double X product to control her GDM. She also took supplement for Vitamin C, Folic Acid and Calcium. She was on Hematinic, Obimin and Ferous as prescribed by the...