RCC hotline was contacted, and Dr. Balqees answered the call.
The case was discussed with her in detail, including the patient’s initial presentation and current clinical condition.
A preterm fetus with an estimated fetal weight of approximately 1.4 kg and previously documented absent end-diastolic flow.
The mother has newly developed severe preeclampsia, associated with ascites and pleural effusion. She also has bilateral polycystic kidney disease.
The case was declined for transfer. Dr. Balqees advised involvement of Nephrology and Gastroenterology teams and that it be managed at our level of care.
The need for an available NICU bed was discussed. Dr. Balqees confirmed that there was no available NICU bed at her hospital at the time of communication.
@ 13:37
by HANEEN MOHAMMED H ALSADOUN
Obstetrics & Gynecology Department
/ OB Gynecology Resident
WRITTEN BY DR.EMAN ALANAZI
COMMINUCATION NOTE:
NEPHROLOGY WERE CONTACTED REGARDING THIS PATIENT , DR.RAEYD AGREED TO SEE THE PATIENT
@ 11:37
by OMAR KAYID SURUR ALOTAIBI
Obstetrics & Gynecology Department
/ OB Gynecology Consultant
arrangement for urgent ECHO accepted by dr.rasha
@ 11:24
by HANEEN MOHAMMED H ALSADOUN
Obstetrics & Gynecology Department
/ OB Gynecology Resident
WRITTEN BY DR.EMAN ALANAZI
SEEN WITH DR.OMAR ,MRP AND DR.SAIMA COD:
BP: 168/118 REPEATED 170/95
PLAN:
LABETALOL 40 MG IV STAT
MGSO4 LODAING DOSE OF 4G IV STAT THEN MAINTAINANCE DOSE OF 1G/HR IV .
@ 10:35
by HANEEN MOHAMMED H ALSADOUN
Obstetrics & Gynecology Department
/ OB Gynecology Resident
written by dr.eman alanazi
patient BP :167/101 , She recived labetalol 100 mg PO @08:40 this morning
plan as discussed with Dr.Haitham , registrar on duty :
-Labetalol 20 mg IV STAT
- BP check after 20 min
- any concerns inform doctor on duty
@ 09:45
by HANEEN MOHAMMED H ALSADOUN
Obstetrics & Gynecology Department
/ OB Gynecology Resident
WRITTEN BY DR.EMAN ALANAZI
SPECULUM EXAMINATION DONE BY DR.SAIMA:
OS CLOSED , NO LIQOUR SEEN , COUGH TEST: NEGATIVE , OS CLOSED ,CERVIX LOOKS NORMAL
-HVS TAKEN
@ 09:14
by HANEEN MOHAMMED H ALSADOUN
Obstetrics & Gynecology Department
/ OB Gynecology Resident
WRITTEN BY DR.EMAN ALANAZI
ROUND WITH DR.SAIMA , CONSULTANT ON DUTY
26 yr old PG
30 wk BY FL
Admitted with severe cellulitis of vulva and IUGR with absent diastolic flow
vulval swelling
- ON IV ANTIBIOTICS : TAZOCIN AND CLINDAMYCIN DAY3
ON EXAM:
BP: 150/83
SPO2: 99% ON ROOM AIR
CHEST: DECREASED BILATERAL EAR ENTRY
PA: FL: 28 wk, ,SOFT, ASCITIS NOTED ,
PV: OS CLOSED , CERVIX , UNEFFACED , BILATERAL LABIAL SWELLING NOTED
LL: BILATERAL PITTING EDEMA
-COMPLETED DEXA
- PROTEIN IN URINE: +1
PLAN AS PER DR.SAIMA:
- BP: 107-149 /65-99 ( AIM FOR 130/85)
- RESTRICT FLUID INTAKE 80ML/HR
- US ABDOMEN AND PELVIS
- NEPHROLOGY AND CARDIOLGY CONSULTATION
- MGSO4 AFTER CONSULTATION WITH MRP
- ECOCARDIOGRAPHY
- RAISE THE BUTTOCKS
- ICE PACK ON VUVLAR SWELLING
- FOR POSSIPLE TRANSFER FOR A HIGHER CENTER FOR MFM SERVICE
- ANY CONCERNS INFORM DOCTOR ON DUTY
@ 05:12
by ABDULLAH NIZAR H ALAMIRI
Obstetrics & Gynecology Department
/ OB Gynecology Specialist
Was called by the midwife as the patient report watery leaking
Pt seen
Doing fine
Not in pain
O/E:
BP = 147/97
P = 62
RR = 20
O2% = 100%
T = 36.8
The right labia appeared to have the leaking
Clear fluid seen dripping from it
PV: Very difficult as pt is uncooperative. No clear liquor seen or felt.
Plan:
- CTG
- New pad and observe
- IV fluids + Paracetamol
- Re-check vitals after 30 minutes from completing paracetamol
- Follow I.M. suggestions
@ 08:01
by MARIA ANITA LUMAMPAO - TE
Obstetrics & Gynecology Department
/ Maternity Nurse
D- DATA:
2300h- Received patient from previous shift on bed awake and responsive a case of primigravida 30weeks OS close with Severe cellulitis of vulva, IUGR., with pedal edema.on normal diet ON HEPARIN 5000 SC BID given at 0600h . according to police mohammed arjani this is not police case. only life saving. she is not in labour. on ctg monitoring reactive no uterine contractions seen, on clindamycin 900 mg IV TID and tazocin injection 4.5 g IV given TID. On fusidic cream. dexamethasone 12mg dose completed . foleys catheter fr14 silicon .with IV fluid RL 500ml at left metacarpal vein gauge 20 line is intact & infusing well. hvs and urine culture done .For daily cbc. & daily doppler. and for intermittent ctg. Medical consultation done Seen by Dr. Mayada for work up by Dr. Zainab today. For Abdominal US today.
A-ACTION:
2320H- Assessed patient , no complaint, with cold compress around vulva. Pain score of 0/10 NRS. Safety measures provided. With ongoing CTG reactive no contractions.
0001h- Vital signs taken and recorded. afebrile.
0200h- Provided cool and calm environment. Patient well rested.
0300h- Blood sample taken for CBC and sent to lab.
0400h- Vital signs taken and recorded. Afebrile.
0500h- Blood sample taken for KFT, LFT and Pt PTT as ordered by IM and sent to lab.
0510h- Perineal care done, changed linens and put on new gown, watery discharge was noted, patient doesn't know from where, and complaining of general body malaise. BP 147/97mmhg. attached to CTG. Informed Dr. Abdullah.
and Came to assess patient:
The right labia appeared to have the leaking
Clear fluid seen dripping from it
PV: Very difficult as pt is uncooperative. No clear liquor seen or felt.
Plan:
- CTG
- New pad and observe
- IV fluids + Paracetamol
- Re-check vitals after 30 minutes from completing paracetamol
- Follow I.M. suggestions
Paracetamol 1g IV given as ordered.
0600h-Due medications given
Clindamycin 900mg IV
Tazocin 4.5g IV given
Heparin 5000 IU SC given
Fucidic cream applied to vulva.
0610h- Emptied urine bag 500ml urine.
0655h- Checked BP 134/90mmhg informed Dr. Abdullah.
R-RESPONSE:
0700H- Endorsed to next shift on duty.
@ 07:58
by MARIA ANITA LUMAMPAO - TE
Obstetrics & Gynecology Department
/ Maternity Nurse
LATE ENTRY FROM 10/7/2026 2300H-0700H
DELETED BY MISTAKE
D- DATA:
2300H- Received patient from previous shift lying on bed awake and responsive a case of primigravida 30weeks OS close with Severe cellulitis of vulva, IUGR with absent diastolic flow, with pedal edema.
on normal diet ON HEPARIN 5000 SC BID given at 1800h . according to police mohammed arjani this is not police case . only life saving. she is not in labour. on clindamycin 900 mg iv TID and tazocin injection 4.5 g iv given at TID 1700h. On fusidic cream. for Doppler study tomorrow, if any abnormality for termination of pregnancy .dexamethasone dose completed . foleys catheter fr14 silicon . hvs and urine culture to follow .daily cbc.
A-ACTION:
2320H- Assessed patient , no complaint, Pain score of 0/10 NRS. Safety measures provided.
Dr. Raziya came and seen the patient, bedside ultrasound done. Attached CTG thereafter.
0001h- Vital signs taken and recorded. afebrile.
0225h- Seen by dr. Reem. CTG tracings seen reactive no contractions.
0300h- Dr. Sheela came and seen the patient, CTG tracings seen reactive no contractions.
0400h- Vital signs taken and recorded. Afebrile.
0435h- Dr. Sheela came and seen the CTG tracings, reactive no contractions.
0500h- Blood sample taken for CBC and sent to lab.
0600h-Due medications given
Clindamycin 900mg IV
Tazocin 4.5g IV given
Heparin 5000 IU SC given
Fucidic cream applied to vulva.
0630h- Emptied urine bag 600ml urine.
R-RESPONSE:
0700H- Endorsed to next shift on duty.
11-07-2026
11-07-2026
@ 23:33
by Mayada Margine Abdelhadi Babeker
Internal Medicine Department
/ Specialist
-IM ON CALL NOTE "
-FOLLOW UP CONSULATION :
- FOR DR-ZAINEB TEAM
-OBS AND GYN CALLED REGARDING FINDING US
-PT ASYMPTOMATIC
B P: 135/ 80 PR: 78 T: 36.8 SAT : 98 RA
PREGNANT GA " 30 WEEK
-NO LFT / NO KFT RESULT
ACCIDENTLY FINDINGS NOTED IN PT
SHE HAS BI LATERALLY POLYCYSTIC KIDNEYS INCREASED ECHOGENICITY AND BILATERALLY MULTIPLE CYST NOTED IN KIDNEYS SIZE MENSION IN IMAGES
PLEURAL EFFUSION NOTED BILATERALLY
FREE FLUID SEEN IN MORISON POUCH
MASSIVE ASCITES NOTED IN RT AND LEFT HYPOCHONDRIUM ADVISE ABDOMINAL ULTRASOUND FOR FURTHER EVALUTION
-RECOMMENDATION "
-LFT , KFT, PTT
-ABDOMINAL US
-ECHO
- NEPHROLOGY REVIEW ( FOR POLYCYSTIC KIDNEY )
-TO BE REVIEW BY DR-ZAINEB TEAM
@ 19:45
by NADA ABDELRAZIK IBRAHIM ALSAYED
Obstetrics & Gynecology Department
/ OB Gynecology Specialist
PT LOOKS WELL
CLINICALY STABLE
VS STABLE
P 82
BP 130/80
SO2 100%RA
TEMP 36.8 C
RR 19
IM ONCALL DR MAYADA INFORMED ABOUT THE CASE , SHE IS BUSY RIGHT NOW AND PT NEED WORK UP
TO CALL DR ZAINAB TEAM TOMOROW
@ 14:43
by NADA ABDELRAZIK IBRAHIM ALSAYED
Obstetrics & Gynecology Department
/ OB Gynecology Specialist
OBS US NORMAL DOPPLER , REDUCED LIQ
PT HAS ACCUMLATION OF FLUID IN THE 3ERD SPACE FOR MED CONSULTATION AGAIN , CALLED MANY TIMES NO ANSWER .
FOR ABDOMINAL US
@ 10:15
by NADA ABDELRAZIK IBRAHIM ALSAYED
Obstetrics & Gynecology Department
/ OB Gynecology Specialist
PT WELL
NO NEW COMPLAINS
STILL WITH BILATERAL LABIAL SWELLING ON ABX
O/E VS STABLE AFEBRILE
P/A SOFT LAX NO CONTRACTIONS
LABIAL SWELLING SAME AS I SAW YESTERDAY
NO PV LOSS
CTG CAT 1 WITH NO CONTRACTIONS
PLAN
FOR US OBS + U/A DOPPLER
CONTINUE SAME PLAN OF MANAGEMENT
INTERMITTENT CTG
@ 00:38
by SHEELA - - NALINI
Obstetrics & Gynecology Department
/ OB Gynecology Specialist
26 yr old primi 30 wk preg admitted with severe cellulitis of vulva
us IUGR with absent diastolic flow
??insect bite ? deep abscess ?? allergy
vulval swelling improved markedly
No complaints other than pain and swelling
no abdominal pain , no pv loss, fm good
o/e
p/a ut 26 wk, fh good,soft abdomen, no contraction or tenderness
v/e not done
legs swelling reduced vulval swelling reduced
completed inj dexamethasone
plan
monitor vitals
continue antibiotic
continue inj Heparin
inj Paracetamol 1 gm iv q 6 hrly for 1 day
cold compress
follow labs
ctg
fkc
daily doppler
if any ctg abnormality or doppler reversal for lscs
keep pedia informed
@ 23:01
by RUBERITA MONJARDIN
Obstetrics & Gynecology Department
/ Maternity Nurse
D- DATA:
15:00H -Received patient from previous shift on bed awake and responsive a case of primigravida 30weeks OS close with Severe cellulitis of vulva, IUGR., with pedal edema.on normal diet ON HEPARIN 5000 SC BID given at 0600h . according to police mohammed arjani this is not police case. only life saving. she is not in labour. on ctg monitoring reactive no uterine contractions seen, on clindamycin 900 mg iv TID and tazocin injection 4.5 g iv given at TID 1700h. On fusidic cream. for Doppler done today, dexamethasone 12mg dose completed . foleys catheter fr14 silicon .with IV fluid RL 500ml at left metacarpal vein gauge 20 line is intact & infusing well. hvs and urine culture to follow .daily cbc. & daily doppler. intermittent ctg.
A-ACTION:
15:05H -Vitals signs taken & recorded, 0/10 pain score using NRS. all safety precautions for falls was applied.
16:00H -Cold compress was applied.
18:00H -Heparin 5000iu subcutaneous given at right arm.
19:00H -Dinner was served & tolerated
19:40H -Patient ushered to toilet to passed stool, done and hygiene by herself.
19:45H -Noted from Dr. Nada specialist;
IM ONCALL DR MAYADA INFORMED ABOUT THE CASE , SHE IS BUSY RIGHT NOW AND PT NEED WORK UP
TO CALL DR ZAINAB TEAM TOMOROW
19:40H -Dr. Nada seen the ctg tracing.
20:00H -Vitals checked & recorded.
21:00H -Perineal care and foleys catheter care done. keep dry & cleaned.
22:00H -All due medications given as ordered.
R-RESPONSE
23:00H -Vitals stable, ctg reactive without uterine contractions occurs, total urine output clear 600ml. for further management, endorsed to the next shift.
@ 14:47
by HADIR MOHAMMED Abdelaziz
Obstetrics & Gynecology Department
/ Maternity Nurse
D- DATA:
@11/07/2026@0700H- Received patient from night shift lying on bed awake and responsive a case of primigravida 30weeks OS close with Severe cellulitis of vulva, IUGR with absent diastolic flow, with pedal edema.on normal diet ON HEPARIN 5000 SC BID given at 0600h . according to police mohammed arjani this is not police case . only life saving. she is not in labour. on clindamycin 900 mg iv TID and tazocin injection 4.5 g iv given at TID 0600h. On fusidic cream. for Doppler daily , if any abnormality for termination of pregnancy .dexamethasone dose completed . with foleys catheter fr14 silicon . hvs and urine culture to follow .daily cbc.ctg ongoing normal fetal heart rate with no contraction .abdomen palpatation small baby size .with iv fluids rl on going and infusing well .
A-ACTION:
@11/07/2026@0700hrs Assessed patient sleep on bed . Safety measures provided. Vital signs taken and recorded. afebrile.
@0800hrs health education about personal care and deep breathing to reduce pain given to her .
@0900hrs montoring her .close absorvation to her .cold compresses applied to vulva .
@0930hrs reassurance her .phychological support provided .place her in comfortable position .
@1000hrs patient Seen by dr.nada . CTG tracings seen reactive no contractions and noted also vagina and advised disattach ctg for intermittent ctg and let her eat and sleep . Vital signs taken and recorded. Afebrile.
@1030hrs patient eaten her break fast normal diet .
@1100hrs patient sleep well .
@1200hrs Vital signs taken and recorded. Afebrile.paracatamol 1 gm iv in given to her as ordered .
@1230hrs US OBS + U/A DOPPLER done by dr/hamida .reduce liquior .and patient has problems in both kidney and advised for abdominal utrasound but dr/nada call the doctor told busy .i return bak to ld with patient .
@1330hrs patient eaten her lunch normal diet .
@1345hrs perineal care done .all morning care done .bed sheet changed .underpad changed ..place her in comfortable position .
@1400h-attach ctg again .Vital signs taken and recorded. Afebrile.Due medications given as ordered .Clindamycin 900mg IV.
Tazocin 4.5g IV given
Fucidic cream applied to vulva.
@1430h- Emptied urine bag 300ml urine.dr/nada call medical but no body answer.
@1450h- all patient needs was attended .
R-RESPONSE:
@11/07/2026@1500H- conscious .alert and well oriented .vitally stable .for abdominal ultrasound and medical consultation .
@1500hrs Endorsed to next shift on duty for continuity of care and management .
10-07-2026
10-07-2026
@ 15:45
by LAMIA BABEKER EBRAHIM ELNOUR
Obstetrics & Gynecology Department
/ OB Gynecology Specialist
ptn seen
no active complain
vitally stable
ctg cat 1
plan:
continue previous orders
@ 11:22
by RAZIYA BANU MOHMED HUSEN GIRACH
Obstetrics & Gynecology Department
/ OB Gynecology Specialist
26 yr, Ethopion , PG 30 week severe IUGR with High RI / ? absent EDF
admitted with bilateral Labial swelling
good FM
fkc : normal
Morning CTG reactive
USG : EFW : 1.4 KG RI : 0.8
On Tazocin + Clindamycin
Cold sponging
Dexa completed
PLAN
patient for shifting to labour room for continuous CTG monitoring
Continue IV antibiotic
Referral can not be sent due to non elligibility of the patient
@ 10:09
by LAMIA BABEKER EBRAHIM ELNOUR
Obstetrics & Gynecology Department
/ OB Gynecology Specialist
26 years
pg
ga:30w+
us:absent EDF
pain and swelling improved
vitally stable
ctg cat 1
cbc;wnl wbc6.6 ,hb:12.4 plt 275
plan :
- continueTazocin 4.5 gram iv tid
- continue clindamycin 900 mg iv tid
- iv hydration
- oral hydration 2000 ml at least per day
- ctg tid
- continue dexamethasone: to complete 2nd dose
- continue enoxaparin
- daily CBC
- follow cultures and swaps
- continue diclofenac gel & Fuscdine
- continue ice packing with covered by 40 by 40 gauze
- for Doppler study tomorrow, if any abnormality for termination of pregnancy as case already dx absent end diastolic flow initially
@ 06:16
by OMAR KAYID SURUR ALOTAIBI
Obstetrics & Gynecology Department
/ OB Gynecology Consultant
Reassessment done bedside: pt seen in stable condition.
pain improved
Upon examination: there is interval reduction of labial swelling Marked , no discharge seen at time of exam, the swelling is soft fluctuant , smooth no hard mass felt
CTG: reactive with no contractions
plan :
- Start Tazocin 4.5 gram iv tid
- clindamycin 900 mg iv tid
- iv hydration
- oral hydration 2000 ml at least per day
- ctg tid
- continue dexamethasone: to complete 2nd dose
- continue enoxaparin
- daily CBC
- follow cultures and swaps
- add diclofenac gel to Fuscdine
- continue ice packing with covered by 40 by 40 gauze
- for Doppler study tomorrow, if any abnormality for termination of pregnancy as case already dx absent end diastolic flow initially
@ 06:00
by ABDULAZIZ KHALID A AL MANA
Obstetrics & Gynecology Department
/ OB Gynecology Resident
AS PER DR NADA
STOP METRONIDAZOLE
GIVE CLINDAMYCIN 800mL TID IV
@ 05:58
by ABDULAZIZ KHALID A AL MANA
Obstetrics & Gynecology Department
/ OB Gynecology Resident
GS CONSULTED REGARDING THERE OPINION ON THE SWELLING
THEY SAID THAT THIS IS A OBGYN CASE DUE TO THE PERINEAL AREA INVOLVEMENT
THEY SAID TO CONTACT THEM IF THEY NEED FURTHER CARE IN THE CASE
@ 05:51
by ABDULAZIZ KHALID A AL MANA
Obstetrics & Gynecology Department
/ OB Gynecology Resident
AS PER DR OMAR & DR NADA
PLEASE STOP CEFUROXIME
BEGIN TAZOCIN 4.5MG TID IV
@ 04:28
by NADA ABDELRAZIK IBRAHIM ALSAYED
Obstetrics & Gynecology Department
/ OB Gynecology Specialist
PLEASE DO
CBC , CRP , ESR , HBA1C ,URINE CULTURE
@ 01:14
by OBAY ELSHEIKH ELTAYEB WAD AZRAG
Internal Medicine Department
/ Internal medicine Specialist
26 YEAR-OLD UNKNOWN FEMALE SEEN
IN OB&GYNE SHE IS PG AT 26 WEEKS
HER MAIN COMPLAINT IS VULVAL SWELLING
AND PAIN
PMH NO PMH OF NOTE
NKDA
PSH NO PSH OF NOTE
SH MARRIED
ALERT ,ORIENTED
VITAL BP 126/88 PR 20 /MIN SPO2 100% ON RA T 36.6 RR 20
CHEST CLEAR HEART S1+S2+0
ABD SOFT AND LAX
CNS INTACT
LL: BILATERAL EDEMA
PLEASE THAT PT HAS ONLY LL EDEMA NO CLINICAL LL CELLULITIS
AND US USUALLY REPORTS LL EDEMA AS CELLULITIS
SUGGESTIONS :
JUST TREAT THE PT VULVAL ISSUE
IF NEEDED CALL DR.ZAINAB TEAM OR IM ON CALL TEAM
@ 22:57
by SHAGAN Saad
Obstetrics & Gynecology Department
/ Maternity Nurse
- DATA:1500h
Received patient from morining shift , conscious oriented ambulatory primigravida 7 months 30weekes with labial swelling, on normal diet ON HEPARIN 5000 SC BID given at 06.00am . according to police mohammed arjani this is not police case . only life saving. she is not in labour. on clindamycin 900 mg iv and tazocin injection 4.5 mg iv given at 09.00am in ob ward . for Doppler study tomorrow, if any abnormality for termination of pregnancy .dexamethasone dose completed . foleys catheter inserted . hvs and urine culture to follow .daily cbc.
ACTION :
A-ACTION:
1500H ASSESS THE PATIENT CHECK VITAL SIGNS AND RECORDED KEEP PATIENT COMFORTABLE
1500H ON CTG REACTIVE
1530H START MGSO4 1G AS ORDER
1630H PSYCHOLOGICAL SUPPORT GIVEN
1630h PATIENT ON THE BED NO COMPLAIN
1600H ON CTG REACTIVE
1630h SEE THE CTG BY DRC LAIMA
1630H PATIENT ON THE BED SLEEPING NO COMPLAIN CTG REACTIVE
CHECK VITAL SIGNS AND RECORDED
1700H GIVEN HERE MEDICATION ON THE TIME TAZCIN INJ AND CLINDAMYCIN
Tazocin + Clindamycin
1800H GIVEN HEPARIN 5000S/C BID AS ORDER
1830H ON CTG REACTIVE
1930HPATIENT STABLE CONDATION ONCTG REACTIVE
2030H ON COMFATABLE POSITION
2130H CTG REACTIVE SEE BY DR REEM
2200H BUT THE diclofenac gel & Fuscdine
R-RESPONSE 10/07/2026@2300H
2300H PATIENT VITALLY STABLE. . FOR CONTINUITY OF CARE. SENDORSED TO NEXT SHIFT on ctg
@ 14:32
by ANJU ShAJI
Obstetrics & Gynecology Department
/ Maternity Nurse
D- DATA:12.30h Received patient from ob ward bed awake, conscious oriented ambulatory primigravida 7 months with labial swelling, on normal diet ON HEPARIN 5000 SC BID given at 06.00am . according to police mohammed arjani this is not police case . only life saving. she is not in labour. on clindamycin 900 mg iv and tazocin injection 4.5 mg iv given at 09.00am in ob ward . for Doppler study tomorrow, if any abnormality for termination of pregnancy .dexamethasone dose completed . foleys catheter inserted . hvs and urine culture to follow .daily cbc.
ACTION :
12.35H Change patient to hospital gown
12.40h Ctg attached
13.00h given lunch o the patient .
14.00h positioning done ctg seen
R-RESPONSE
15.00h endorsed to next duty staff
@ 11:38
by CHERRY ANN PARDO
Obstetrics & Gynecology Department
/ Maternity Nurse In charge
0700h— Received patient on bed awake, conscious oriented
ambulatory primigravida 7 months with labial swelling
, on normal diet ON HEPARIN 5000 SC BID
pain score of 0 using NRS,afebrile according to police mohammed arjani this is not police case . only life saving. she is not in labour.
A-ACTION:
0800h- Vital signs checked and recorded
encourage ambulation
encourged a proper hygiene
0900h - clindamycin 900 mg iv given tazocin 4.5 mg iv given skin test negative
1009h - seen by Dr Lamya continue Tazocin 4.5 gram iv tid
- continue clindamycin 900 mg iv tid
- iv hydration
- oral hydration 2000 ml at least per day
- ctg tid
- continue dexamethasone: to complete 2nd dose
- continue enoxaparin
- daily CBC
- follow cultures and swaps
- continue diclofenac gel & Fuscdine
- continue ice packing with covered by 40 by 40 gauze
- for Doppler study tomorrow, if any abnormality for termination of pregnancy as case already dx absent end diastolic flow initially
1122h - seen by Dr Raziya patient for shifting to labour room for continuous CTG monitoring
Continue IV antibiotic
Referral can not be sent due to non elligibility of the patient
1200h - vital signs checked and recorded
R- RESPONSE
1230H- - patient is stable endorsed TO LABOR ROOM
@ 03:51
by MA. LOURDES CAMPULLO
Obstetrics & Gynecology Department
/ Maternity Nurse
D- DATA:
2300-Received patient on bed awake, conscious oriented
ambulatory primigravida 7 months with labial swelling
, on normal diet
pain score of 0 using NRS,afebrile
A-ACTION:
2400-Vital signs checked and recorded
0100-encourage ambulation
0200-seen at intervals
0300-psychological support given
0400-vital signs checked and recorded
0600-ctg attached kept in left lateral position
ctg reactive
R-RESPONSE:
0700-Patient needs further care, endorsed
09-07-2026
09-07-2026
Progress Notes
@ 22:43
by NADA ABDELRAZIK IBRAHIM ALSAYED
Obstetrics & Gynecology Department
/ OB Gynecology Specialist
IV METRONEDAZOL 500 MG TID
ICE BAG
FUSCIDINE CREAM LOCALLY TID
LIDOCAIN CREAM LOCALLY TID
@ 20:42
by ABDULAZIZ KHALID A AL MANA
Obstetrics & Gynecology Department
/ OB Gynecology Resident
LOW VAGINA AND HIGH VAGINA ATTEMPTED TO TAKE,
PLEASE NOTE THAT IT WAS DONE WITH GREAT DIFFICULT AS PT WAS IN PAIN AND WITH GREAT DIFFICULTY
NO VAGINA SECRETIONS WERE NOTED
LABIA WAS INFLAMMED AND VERY TENDER
@ 20:30
by ABDULAZIZ KHALID A AL MANA
Obstetrics & Gynecology Department
/ OB Gynecology Resident
ADMISSION NOTE
26 yr old
PG
PMH: Free
PSH: Free
GA 7 MONTHS???
married since 1 yr with spontaneous conception
c/o severe bilateral lower limb oedema and labial oedema of ???1 day duration
pt c/o swelling and pain of 1 day duration ,no h/o trauma, fever or leaking or abdominal pain
fm good
P/E:
T : 37.2 Cel
RR : 20 /min
PR : 88.00 /min
Sys : 128 mmHg
Dia : 87 mmHg
SPO : 99 %
pt cannot close her legs b/c of severe labial cellulitis
not anemic, not jaundiced
Vitals:
P/A: cephalic, fh good . no contractions or tenderness
v/e cannot be done
massive cellulitis of both labia and both lower limb
lower legs no tenderness or signs of DVT
but severe cellulitis of both labia majora and whole vulva
labial swelling is very tender.....?? some abscess deep .
b/l lower leg doppler... done and no evidence of DVT...only cellulitis.
Plan
monitor vitals
insert Foley's catheter
urine analysis and c&s
output chart
cbc, rbs, kft, lft,coagulation profile
crossmatch 2 units of PRBC
blood culture
hvs
low vaginal swab culture
us pelvis done ....absent diastolic flow..liquor adequate.efw 1.47 kg
ctg ..for the time being ctg q 8 hr with FKC ...for shifting to L&D if ctg any abnormality...
daily doppler study of umbilical artery .if it reverse for immediate lscs
inj ceftriaxone 1 gm iv q 12hr
tab Cetrizine 10 mg q 24 hr
inj Dexamethasone 12 mg q12 hr x 2 doses
hot compress
injHeparin 5000 iu sub q q12 hr
proper examination after cellulitis reduced
any ctg abnormality for lscs
informed pedia ...in case of emergency can arrange 1 bed.
@ 20:25
by ABDULAZIZ KHALID A AL MANA
Obstetrics & Gynecology Department
/ OB Gynecology Resident
CTG NOT DONE IN ER, PLEASE DO CTG IN WARD
@ 17:39
by SHEELA - - NALINI
Obstetrics & Gynecology Department
/ OB Gynecology Specialist
seen the pt in ER
26 yr old primi married since 1 yr with spontaneous conception and at 7 months and 10 days with c/o severe bilateral lower limb oedema and labial oedema of ???1 day duration
pt c/o swelling and pain of 1 day duration ,no h/o trauma, fever or leaking or abdominal pain
fm good
medically and surgically free according to pt
o/e
pt cannot close her legs b/c of sevre labial cellulitis
not aneamic, not jaundiced
bp normal. pr normal, temp normal
o/e p/a ut 26 wk, cephalic, fh good . no contractions or tenderness
v/e cannot be done
massive cellulitis of both labia and both lowerlimb
lower legs no tenderness or signs of DVT
but sevre cellulitis of both labia majora and whole vulva
single digital examination done and cannot find any swelling inside as examination is very difficult.
but some fluid was draining ..not sure liquor or not ...most probably not liquor
labial swelling is very tender.....?? some abscess deep .
plan
admission after explaining to the pt about the diagnosis ,need for termination of pregnancy ,no nicu bed and cannot send fax..if the family accepts for admission
monitor vitals
insert Foley's catheter
urine analysis and c&s
output chart
cbc, rbs, kft, lft,coagulation profile
crossmatch 2 units of PRBC
blood culture
hvs
low vaginal swab culture
us pelvis done ....absent diastolic flow..liquor adequate.efw 1.47 kg
ctg ..for the time being ctg q 8 hr with FKC ...for shifting to L&D if ctg any abnormality...
daily doppler study of umbilical artery .if it reverse for immediate lscs
b/l lower leg doppler... done and no evidence of DVT...only cellulitis.
inj ceftriaxone 1 gm iv q 12hr
tab Cetrizine 10 mg q 24 hr
inj Dexamethasone 12 mg q12 hr x 2 doses
hot compress
injHeparin 5000 iu sub q q12 hr
proper examination after cellulitis reduced
any ctg abnormality for lscs
informed pedia ...in case of emergency can arrange 1 bed.
@ 15:29
by HANEEN MOHAMMED H ALSADOUN
Obstetrics & Gynecology Department
/ OB Gynecology Resident
we receive patient through ambulance
as a case of euthiopian lady with stromg language barrier
PG
LMP : unsure
GA : 7 months ?
we receive the patient as complaining of bilateral labial swelling with edema and bilateral labial redness
on exam :
there is bilateral labial tenderness
PA : soft+lax
vitally stable
afebrile
official us done showed :
SVF PORTABLE SCAN DONE
CEPHALIC PRESENTATION
FM+VE FHB +VE
PLACENTA UPPER ANTERIOR
LIQUAR ADEQUATE
BPD=30W+5D
AC=29W
FL=30W+5D
EFW=1470G
DOPPLAR STUDY U/A RI=0.81
NO DIASTOLIC FLOW SEEN INFORMED ON DUTY SPECIALIST
patient received 100 mg iv stat hydrocrtisone + paracetamol 1 gram stat + iv fluids
all labs dropped including routin e labs + septic workup + crp + esr
PLAN PER DR SHAILA :
follow up all labs
pnumatic pressure
ceftriaxone 2 gram stat iv
consider prophylactic enoxaparine 40 mg od sc
follow up bilateral lower limbs doppler
iv fluids
Albumin
Order Date : 12-07-2026 08:43
Careprovider : HANEEN MOHAMMED H ALSADOUN
Report Authorised
Albumin in Serum or Plasma
26
(32 - 48) g/L L Approved from Review Results
Protein Serum
Order Date : 12-07-2026 08:43
Careprovider : HANEEN MOHAMMED H ALSADOUN
Report Authorised
Protein in Serum or Plasma
4.7
(57 - 82) g/L L Approved from Review Results
KFT
Order Date : 12-07-2026 04:00
Careprovider : HANEEN MOHAMMED H ALSADOUN
Report Authorised
Creatinine in Serum or Plasma
63
(62 - 115) µmol/L N Approved from Review Results..
Potassium in Serum or Plasma
4.81
(3.5 - 5.1) mmol/L N Approved from Review Results
Sodium in Serum or Plasma
142
(136 - 145) mmol/L N Approved from Review Results..
BUN (Blood Urea Nitrogen)/serum
10.0
(3.2 - 8.2) mmol/L H Approved from Review Results..
Chloride in Serum or Plasma
111
(98 - 107) mmol/L H Approved from Review Results..
LFT
Order Date : 12-07-2026 04:00
Careprovider : HANEEN MOHAMMED H ALSADOUN
Report Authorised
Alanine Aminotransferase
14
(9.1 - 49.1) U/L N Approved from Review Results
Alkaline Phosphatase
162
(46 - 116) U/L H Approved from Review Results..
Bilirubin, Total
3
(4.9 - 21.1) µmol/L L Approved from Review Results..
Aspartate Aminotransferase
29
(13 - 40) U/L N Approved from Review Results..
Bilirubin Direct in Serum
< 2
(0.0 - 5.1) µmol/L N Approved from Review Results..
PT(PT+PTInr)+PTT
Order Date : 12-07-2026 04:00
Careprovider : HANEEN MOHAMMED H ALSADOUN
Report Authorised
INR
1.07
(0.8 - 1.2) sec N Approved from Review Results..
APTT
33.8
(26 - 40) sec N Approved from Review Results..
PT
14.3
(11.0 - 16.1) sec N Approved from Review Results
CBC
Order Date : 12-07-2026 02:15
Careprovider : HANEEN MOHAMMED H ALSADOUN
Report Authorised
MPV
9.5
(6.3 - 10.3) fL N Approved from Review Results..
Red Cell Distribution Width ( RDW ) (CV)
15.5
(11.5 - 14.5) % H Approved from Review Results..
WBC
7.68
(4 - 11) 10*3/uL N Approved from Review Results
RBC
4.74
(4.0 - 5.4) 10*6/uL N Approved from Review Results..
Hemoglobin
11.6
(12 - 16) g/dL L Approved from Review Results..
Hematocrit
34.7
(36 - 54) % L Approved from Review Results..
MCV
73.2
(76 - 96) fL L Approved from Review Results..
MCH
24.5
(27 - 32) pg L Approved from Review Results..
MCHC
33.4
(32 - 35) g/dL N Approved from Review Results..
Platelets
323
(150 - 400) 10*3/uL N Approved from Review Results..