• Name: Mrs. Kavya S    W/o: Mr. Suresh M
• Age: 24 years
• IP/OPD Registration No: OPD/2026/0412
• Date of Admission/Visit: 12/07/2026
• Address: No. 5, Rose Nagar, Bangalore - 560001

• Gravida: G2   Parity: P1   Living: 1   Abortion: 0
• LMP: 05/01/2026   EDD: 12/10/2026
• Gestational Period: 27 weeks   Yrs/Month Married: 3 years

• Education (Wife): Graduate    (Husband): Graduate
• Occupation (Wife): Homemaker    (Husband): Software Engineer
• Family Income: ₹45,000/month
• Type of House: Pucca   No. of Rooms: 3   Ventilation: Adequate
• Sanitation Facilities: Proper indoor toilet, running water

• Type of Family: Nuclear   No. of Members: 3   Adults: 2   Children: 1
• Hereditary Diseases: None
• History of Twins: None

• Sleep: 7-8 hrs/day   Appetite: Good   Allergy: None
• Habits: None   Addiction: None
• Diet: Non-Vegetarian   Meals/Day: 3
• Bladder/Bowel Habits: Normal

• Childhood Illness: None
• Thyroid/Asthma/Epilepsy: None
• Long-term Drugs/Blood Transfusion: None
• Previous Surgery: None

• Age of Menarche: 13 years
• Amount of Bleeding: Moderate   Cycle: Regular   Interval: 28 days
• Associated Problems: Mild dysmenorrhea
• Treatment Taken: No

• Marital Status: Married
• Age at Marriage: 21 years   Years of Marital Life: 3 years (stays with husband)
• Consanguineous Marriage: No
• Use of Contraceptive: Yes - OCP used for 1 year after first delivery; stopped 1 year ago
• Any Treatment for Infertility: No

• No. of Living Children: 1   Girls: 1   Boys: 0
• Abortions: 0   Spontaneous: 0   MTP: 0
• Age of First Child: 2 years   Age of Last Child: 2 years
• Any Congenital Abnormality/Disease in Children: None

• General Health during Present Pregnancy: Good
• Complaints during Pregnancy: Mild nausea in 1st trimester, occasional backache
• Morning Sickness: Yes (1st trimester, resolved by 14 weeks)
• Minor Ailments: Mild ankle edema since 24 weeks
• Date of First Visit/Registration for ANC: 10/02/2026 (at 6 weeks)
• Gestational Age at First Visit: 6 weeks
• Immunization (T/T): Yes   1st Dose: 15/02/2026   2nd Dose: 15/03/2026
• Calcium, Iron & Folic Acid Supplements: Tab. Folic Acid 5mg OD (1st trimester); Tab. Ferrous Sulphate 200mg BD + Tab. Calcium 500mg BD (from 14 weeks)
• Any Other Medications During Pregnancy: Tab. Vitamin D3 60,000 IU once a month (from 20 weeks)

• Morning Sickness: Yes - Mild - T/T taken: Tab. Ondansetron 4mg SOS
• Bleeding P/V: No - T/T taken: Nil
• Any Other Significant Problems: None
• Antenatal Visits/Reports - Height: 154 cm   Weight: 52 kg
• B.P: 110/70 mmHg
• Hb%: 10.8 g/dL
• Urine - Albumin: Nil   Sugar: Nil
• USG Report/Findings: Single live intrauterine pregnancy, CRL consistent with 8 weeks, no anomaly detected

• Minor Ailments: Mild backache, ankle edema   Any T/T/Medications: Tab. Calcium 500mg BD, Tab. Ferrous Sulphate 200mg BD
• Hospitalization: No
• Quickening: 18 weeks
• Fetal Movements: Present and adequate
• Any Other Significant Problems: None
• Antenatal Visits/Reports - Height: 154 cm   Weight: 57 kg
• B.P: 116/74 mmHg
• Hb%: 10.2 g/dL
• Urine - Albumin: Nil   Sugar: Nil
• USG Report/Findings: Anomaly scan at 20 weeks - single live fetus, no structural anomalies, placenta anterior, liquor adequate

• Minor Ailments: Mild pedal edema, occasional heartburn   Any T/T/Medications: Tab. Antacid SOS, Tab. Calcium continued
• Hospitalization: No
• Fetal Movements: Present, good (10 movements/12 hours)
• Any Other Significant Problems: None
• Antenatal Visits/Reports - Height: 154 cm   Weight: 62 kg
• B.P: 118/76 mmHg
• Hb%: 10.6 g/dL
• Urine - Albumin: Nil   Sugar: Nil
• USG Report/Findings: Growth scan at 32 weeks - cephalic presentation, AFI normal (12 cm), EFW 1.8 kg, placenta anterior grade II

• Body Built: Average
• Appearance/Gait: Normal gait, well-oriented
• Nourishment: Average

• Temperature: 98.6°F (37°C)
• Pulse: 84 beats/min, regular, good volume
• Respiration: 18 breaths/min
• Blood Pressure: 118/76 mmHg

• Hair - Texture: Smooth   Colour: Black, mild thinning noted
• Scalp - Cleanliness: Clean, no dandruff or lice

• Teeth: No dental caries
• Gums: No hypertrophy or bleeding
• Tongue: Moist, no coating
• Lips: Moist, no pallor or cheilosis

• Inspection & Palpation:
  • Thyroid enlargement: None
  • Lymph node enlargement: None

• Lungs: Clear on auscultation, no added sounds
• Heart Sounds: S1 S2 heard, no murmurs

• Inspection - Symmetry: Bilateral symmetrical
• Primary and Secondary Areola: Present, hyperpigmented (normal in pregnancy)
• Montgomery's Tubercles: Present
• Nipples: Erectile, not retracted, no cracks
• Palpation: No lumps, colostrum present on expression (right side)

• Size of Abdomen: Large - corresponding to POG (27 weeks)
• Shape of Abdomen: Longitudinally ovoid
• Contour of Abdomen: Fullness of flanks, firm
• Umbilicus: Flat (becoming everted)
• Bladder: Not full
• Skin Changes: Linea nigra present, striae gravidarum (pink/white) present
• White/Pink Scars: None
• Visible Fetal Movements: Present

• Abdominal Girth: 82 cm (at level of umbilicus)
• Fundal Height (SFH): 27 cm
• Fundal Height in Weeks: 27 weeks (corresponds to POG)

• Lie: Longitudinal
• Presentation: Cephalic (soft, non-ballotable mass at fundus - breech felt at fundus)

• Position: LOA (Left Occipito-Anterior)
• Fetal back felt on left side - smooth, firm, resistant
• Fetal limbs felt on right side - irregular, knobby

• Rate/min: 148 beats/min, regular
• Located: Left lower quadrant (LLQ) - below umbilicus on left side

• Free/Engaging/Engaged: Free (head not yet engaged - 27 weeks)

• Mobile/Fixed/Flexed/Deflexed: Mobile, Flexed
• Estimated 5/5 palpable above pelvic brim

• Varicose Veins: Absent
• Ankle Edema: Present - mild, pitting (+1), bilateral, more towards evening, non-tender

• Excessive Discharge: Mild whitish discharge, no foul smell (physiological leucorrhea of pregnancy)
• Foul Smell/Bleeding/Show: Absent
• Vulval Edema: Absent
• Vulval Varicosity: Absent

• High Risk: Mild anaemia (Hb 10.6 g/dL)
• Low Risk: Mild ankle edema (physiological), mild backache
• Remarks: Patient is a G2P1L1, currently 27 weeks, otherwise progressing normally. Iron supplementation continued and diet counselling given.

• Nutrition: Advised iron and protein-rich diet - green leafy vegetables, dal, eggs, milk, fruits. Avoid tea/coffee with meals (reduces iron absorption). Increase calcium intake - milk, curd, ragi. Adequate hydration (8-10 glasses of water/day).
• Follow Up: Advised to visit ANC clinic every 4 weeks until 28 weeks, every 2 weeks from 28-36 weeks, and weekly after 36 weeks. Next visit scheduled on 09/08/2026.
• Rest & Sleep: Advised 8 hours of sleep at night, 1-2 hours rest in the afternoon. Sleep in left lateral position to improve uteroplacental blood flow. Elevate legs to reduce ankle edema.
• Exercise & Work: Advised light household work, avoid heavy lifting and prolonged standing. Short walks of 20-30 minutes daily are beneficial. Avoid strenuous activity.
• Use of Comfort Devices: Advised to use supportive maternity bra for breast support. Comfortable, flat footwear to reduce backache and edema.
• Warning Signs Explained: Advised to report immediately if any of the following occur:
  • Severe headache, blurring of vision
  • Sudden swelling of face/hands/feet
  • Decreased or absent fetal movements
  • Vaginal bleeding or gush of fluid
  • High fever, severe abdominal pain
  • Burning micturition
• Minor Discomforts & Remedies: Backache - advised pelvic tilt exercises, correct posture. Ankle edema - elevate legs, reduce salt intake, avoid prolonged standing. Heartburn - small frequent meals, avoid spicy food, do not lie down immediately after eating.
• Sex: Advised that sexual intercourse is generally safe in uncomplicated pregnancy but should be avoided if any bleeding, leaking of fluid, or discomfort occurs.
• Signs & Symptoms of True Labour: Explained - regular, painful uterine contractions increasing in frequency and intensity; blood-stained show; rupture of membranes. Advised to come to hospital immediately when any of these occur.

• Name: Mrs. Priya R    W/o: Mr. Ramesh K
• Age: 28 years
• IP/OPD Registration No: OPD/2026/0789
• Date of Admission/Visit: 12/07/2026
• Address: No. 12, Tulsi Nagar, Mysore - 570004
• Religion: Hindu    Hospital: District Government Hospital, Mysore

• Gravida: G1   Parity: P0   Living: 0   Abortion: 0
• LMP: 12/10/2025   EDD: 19/07/2026
• Gestational Period: 39 weeks   Yrs/Month Married: 2 years

• Education (Wife): PUC (12th std)    (Husband): Diploma
• Occupation (Wife): Homemaker    (Husband): Auto Driver
• Family Income: ₹18,000/month
• Type of House: Pucca   No. of Rooms: 2   Ventilation: Adequate
• Sanitation Facilities: Indoor toilet, municipal water supply

• Type of Family: Nuclear   No. of Members: 2   Adults: 2   Children: 0
• Hereditary Diseases: Maternal grandmother - Type 2 Diabetes
• History of Twins: None (Maternal/Fraternal: Nil)
• Any Other Significant History: None

• Sleep: 7 hours/day   Appetite: Reduced (3rd trimester)
• Allergy: No known allergy
• Habits: None   Addiction: None
• Bladder & Bowel Habits: Frequency of micturition increased (normal in 3rd trimester); mild constipation
• Diet: Vegetarian   Number of Meals a Day: 4 (small frequent meals)
• Any Significant Diet Habits in Pregnancy: Increased intake of milk, fruits, and green vegetables. Avoids spicy food due to heartburn.

• Childhood Illness/Hepatitis/TB/Communicable Diseases/Diabetes: None
• Thyroid (Hypo/Hyper)/Asthma/Epilepsy: None
• Long Term Drugs/Blood Transfusion: None
• Any Other Significant Illness: None

• Abdominal/Pelvic/Orthopedic Operation: None

• Age of Menarche: 14 years
• Amount of Bleeding: Moderate   Cycle: Regular   Interval: 30 days
• Associated Problems: None
• Treatment Taken: No

• Marital Status: Married
• Age at Marriage: 26 years   Years of Marital Life: 2 years (stays with husband)
• Consanguineous Marriage: No
• Use of Contraceptive: No
• Any Treatment for Infertility: No

• No. of Living Children: 0   Girls: 0   Boys: 0
• Abortions: 0   Spontaneous: 0   MTP: 0
• Age of First Child: N/A   Age of Last Child: N/A
• Any Congenital Abnormality/Disease in Children: N/A

• General Health during Present Pregnancy: Moderately good; fatigue and heaviness noted in 3rd trimester
• Complaints during Pregnancy: Nausea in 1st trimester, heartburn and frequency of micturition in 3rd trimester, backache since 34 weeks
• Morning Sickness: Yes (1st trimester, mild, resolved by 12 weeks)
• Minor Ailments: Heartburn, backache, pedal edema (mild), frequency of micturition, difficulty sleeping
• Date of First Visit/Registration for ANC: 20/11/2025 (at 6 weeks gestation)
• Gestational Age at First Visit: 6 weeks
• Immunization (T/T): Yes   1st Dose: 01/12/2025   2nd Dose: 01/01/2026
• Calcium, Iron & Folic Acid Supplements:
  • Tab. Folic Acid 5 mg OD - from 6 weeks (1st trimester)
  • Tab. Ferrous Sulphate 200 mg BD + Tab. Calcium 500 mg BD - from 14 weeks onwards
• Any Other Medications During Pregnancy: Tab. Vitamin D3 60,000 IU once/month (from 20 weeks); Tab. Antacid (Gelusil) SOS for heartburn

• Morning Sickness: Yes - Mild - T/T taken: Tab. Vitamin B6 10 mg OD
• Bleeding P/V: No
• Any Other Significant Problems: Mild fatigue
• Antenatal Visits - Height: 152 cm   Weight: 48 kg
• B.P: 100/68 mmHg
• Hb%: 9.8 g/dL
• Urine - Albumin: Nil   Sugar: Nil
• USG Report/Findings: Single live intrauterine pregnancy, CRL consistent with 7 weeks, heartbeat present, no anomaly

• Minor Ailments: Heartburn, mild constipation   T/T/Medications: Tab. Antacid SOS, increased fibre and fluid intake advised
• Hospitalization: No
• Quickening: 20 weeks (primi - slightly later)
• Fetal Movements: Present, adequate
• Any Other Significant Problems: None
• Height: 152 cm   Weight: 53 kg
• B.P: 106/70 mmHg
• Hb%: 10.0 g/dL
• Urine - Albumin: Nil   Sugar: Nil
• USG Report/Findings: Anomaly scan at 20 weeks - single live fetus, no structural anomalies detected, placenta posterior, liquor adequate, fetal movements present

• Minor Ailments: Backache, pedal edema, heartburn, frequency of micturition, difficulty sleeping   T/T: Tab. Antacid SOS, advised left lateral position, warm compress for back
• Hospitalization: No
• Fetal Movements: Present, good (10+ movements in 12 hours)
• Any Other Significant Problems: None
• Height: 152 cm   Weight: 59 kg
• B.P: 110/74 mmHg
• Hb%: 10.4 g/dL
• Urine - Albumin: Nil   Sugar: Nil
• USG Report/Findings: Growth scan at 36 weeks - cephalic presentation, engaged, AFI 10 cm, EFW 2.9 kg, placenta posterior grade II-III, no CPD

• Body Built: Average
• Appearance/Gait: Waddling gait (normal at 39 weeks), conscious and oriented
• Nourishment: Average

• Temperature: 98.4°F (36.9°C)
• Pulse: 88 beats/min, regular, good volume
• Respiration: 20 breaths/min
• Blood Pressure: 112/74 mmHg

• Hair - Texture: Dry, mild hair fall noted   Colour: Black
• Scalp - Cleanliness: Clean, no infestation

• Teeth: No dental caries
• Gums: Mild hypertrophy (pregnancy gingivitis), no active bleeding
• Tongue: Moist, slightly pale
• Lips: Moist, mild pallor, no cheilosis or cracks

• Inspection & Palpation:
  • Thyroid enlargement: None
  • Lymph node enlargement: None

• Lungs: Clear bilaterally, no added sounds
• Heart Sounds: S1 S2 heard, no murmurs

• Inspection - Symmetry: Bilateral symmetrical, enlarged (normal in late pregnancy)
• Primary and Secondary Areola: Present, deeply hyperpigmented
• Montgomery's Tubercles: Prominent
• Nipples: Erectile, no retraction, no cracks
• Palpation: No lumps, colostrum expressed bilaterally (normal at 39 weeks)

• Size of Abdomen: Large - corresponding to POG (39 weeks), abdomen appears full and pendulous
• Shape of Abdomen: Longitudinally ovoid, slightly pendulous (common in primigravida at term)
• Contour of Abdomen: Fullness of flanks, firm
• Umbilicus: Protruding/everted (normal at term)
• Bladder: Not full
• Skin Changes: Linea nigra well marked (umbilicus to symphysis pubis), striae gravidarum (pink/purple) prominent on lower abdomen and flanks, striae albicans absent
• White/Pink Scars: None
• Visible Fetal Movements: Present, occasional visible limb movements

• Abdominal Girth: 96 cm (at level of umbilicus)
• Fundal Height (SFH): 38 cm
• Fundal Height in Weeks: 38-39 weeks (corresponds to POG)

• Lie: Longitudinal
• Presentation: Cephalic (soft, irregular, non-ballotable breech felt at fundus)

• Position: LOA (Left Occipito-Anterior)
• Fetal back felt on left side - smooth, firm, continuous, resistant
• Fetal limbs felt on right side - irregular, knobby nodulations

• Rate/min: 150 beats/min, regular, strong
• Located: Left lower quadrant (LLQ) - below and to the left of umbilicus (engaged head, FHS heard low down)

• Free/Engaging/Engaged: Engaged (2/5 palpable above pelvic brim)
• Head has descended into the pelvis - confirms engagement in primigravida at term

• Fixed, Flexed: Head is fixed and well flexed
• 2/5 palpable above pelvic brim - engagement confirmed

• Varicose Veins: Absent
• Ankle Edema: Present - mild pitting edema (+1), bilateral, non-tender, more prominent in the evening (physiological)

• Excessive Discharge: Mild mucoid whitish discharge, no foul odour (increased physiological leucorrhea at term)
• Foul Smell/Bleeding/Show: Absent (no show yet, not in active labour at time of examination)
• Vulval Edema: Absent
• Vulval Varicosity: Absent

• High Risk: Mild anaemia (Hb 9.8 g/dL at booking, improved to 10.4 g/dL); Primigravida at term with engaged head
• Low Risk: Mild pedal edema (physiological), mild chloasma, pregnancy gingivitis, backache, heartburn
• Remarks: Primigravida, 39 weeks, otherwise uncomplicated pregnancy. Head engaged. Patient counselled regarding signs of labour and hospital admission. Delivery expected within 1-2 weeks.

• Nutrition: Advised iron-rich diet - green leafy vegetables (spinach, methi), dal, eggs, jaggery, dates, ragi. Protein-rich foods - milk, curd, pulses, eggs. Calcium-rich foods - milk 2-3 glasses/day, sesame seeds, ragi. Small frequent meals (4-5/day) to manage heartburn and gastric discomfort. Adequate hydration 8-10 glasses/day. Avoid tea/coffee immediately after meals.
• Follow Up: Being at 39 weeks, advised to come immediately if labour pains begin or membranes rupture. If no spontaneous labour by 40 weeks + 7 days, will be reviewed for induction. No routine OPD visit needed unless problem arises.
• Rest & Sleep: 8 hours sleep at night. Sleep strictly in left lateral position - improves uteroplacental circulation and reduces pressure on inferior vena cava. Afternoon rest of 1-2 hours. Avoid lying flat on back (supine hypotension syndrome).
• Exercise & Work: Avoid heavy household work and lifting. Short walks of 15-20 minutes twice daily are beneficial and may help initiate labour. Avoid prolonged standing or sitting. Pelvic floor exercises (Kegel's) taught for labour preparation.
• Use of Comfort Devices: Good supportive maternity bra. Flat comfortable footwear. Maternity pillow between knees while sleeping for back support and comfort.
• Warning Signs Explained: Advised to report immediately to hospital if:
  • Regular painful uterine contractions (every 5-10 mins)
  • Sudden gush or trickle of fluid per vagina (rupture of membranes)
  • Reduced or absent fetal movements (less than 10 in 12 hours)
  • Bleeding per vaginum
  • Severe headache, blurring of vision, swelling of face/hands
  • High fever or burning micturition
• Minor Discomforts & Remedies: Heartburn - small frequent meals, avoid spicy/oily food, sleep with head elevated, Tab. Gelusil SOS. Backache - warm compress, correct posture, avoid high heels, pelvic tilt exercises. Pedal edema - elevate legs when resting, avoid prolonged standing, reduce salt intake. Frequency of micturition - reassured it is normal at term due to engaged head pressing on bladder.
• Sex: Advised to avoid sexual intercourse at 39 weeks as membranes may be sensitive and risk of infection/early labour. Consult doctor if any concerns.
• Signs & Symptoms of True Labour: Explained in detail:
  • Regular painful contractions starting in back, radiating to abdomen, increasing in frequency (every 5 min), duration (>30 sec) and intensity
  • Blood-stained mucoid show (operculum discharge)
  • Spontaneous rupture of membranes (gush/trickle of clear fluid)
  • Advised to come to hospital immediately when any of the above occur, without waiting

MOTIVATING COUPLES FOR PLANNED PARENTHOOD

1. Counseling For Family Planning (Permanent Method)

• Tubectomy: Done                Vasectomy: Not done
• Couples Present: Mr. Ramesh K & Mrs. Priya R
• Number of Children: 1 (newborn delivered 12/07/2026)
• Age of Children: Newborn (0 days)
• Sex - Male/Female: Male

2. COUNSELING FOR FAMILY PLANNING

• Need for family planning - importance of birth spacing (at least 3 years) for maternal and child health; recovery of the mother's body after delivery
• LAM (Lactational Amenorrhoea Method) - explained that exclusive breastfeeding for 6 months provides up to 98% protection against pregnancy; conditions to be fulfilled (exclusive BF, amenorrhoea, baby under 6 months)
• Condoms - explained correct use, availability, dual protection against STIs and pregnancy, no hormonal side effects
• Oral Contraceptive Pills (OCP) - Progestin-only pills (mini pill) safe during breastfeeding; must be taken daily at same time; not recommended in first 6 weeks postpartum
• IUCD (CuT 380A) - can be inserted within 48 hours of delivery (PPIUCD) or after 6 weeks; highly effective for 10 years; no effect on breastmilk
• Injectable contraceptive (DMPA) - Depo Provera 150 mg IM every 3 months; safe during breastfeeding after 6 weeks

• Flip chart with diagrams of temporary methods
• Sample CuT 380A model
• Pamphlets in Kannada on family planning (distributed to all couples)
• Poster on "Hum Do Hamare Do" - small family norm