Pregnancy with Bilateral ovarian cysts ✍🏻

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21 year old patient G3P1L1A1 with Previous Lscs with 38wks 4 days Period of gestation with Hypothyroidism with Bilateral Ovarian cysts.
Wife of Mr.X belongs to low socioeconomic class residing in Hyderabad.

Menstrual history:
Attained menses at the age of 13 years.
Irregular menses , 3-4 days flow per 60-70 days , during periods no pain and no clots.

Obstetric history:
First pregnancy: 
Spontaneous conception / Full term/ LSCS I/v/o transverse lie / female baby/ Birth weight 3 kg/ Alive and healthy / now 3 years of age .(2020)

Second Pregnancy: 
Spontaneous conception / spontaneous Abortion at 5 weeks period of gestation (2022)

Third pregnancy: Spontaneous conception/Present pregnancy
LMP: 13/7/2023
EDD: 20/4/2024
Past history:
K/c/o Hypothyroidism on Tablet Thyronorm 25mcg per oral ; once a day since 8th of pregnancy 
Not a known case of Diabetes, hypertension,Asthma ,Epilespy,Tuberculosis 
Personal history:
Appetite normal 
Bowel and bladder movements regular 
Sleep adequate 
No addictions 

INVESTIGATIONS:
A positive blood group 
2/3/24: CBP
HB: 9.5 g/dl 
Platelets : 318 k/ mm3 
TLC: 11.97 k/mm3 
2/4/2024: 
S.TSH: 3.8 uIU /ml
10/4/2024:
PT 14.6 sec 
INR: 1.13
APTT: 32.2 sec 
RBS: 129 mg/dl 
Serum creatinine : 0.47 

14/09/2023: VIABILITY SCAN: 
Early single intrauterine gestational sac with fetal pole of average gestational age 7 weeks 2 days with large left haemorrhaghic ovarian cyst.
(78x 60mm)
EDD: 1/05/2024

3/10/2023: USG ABDOMEN AND PELVIS 
Uterus Gravid uterus with single live intrauterine gestation corresponding to 10 weeks 1 day with FHR 176 bpm 
Left ovary: a cystic lesion 53x32x49 mm with few internal septa with in noted in left ovary, left ovary could not be visualised separately.
Right ovary: 30x 19 mm normal in size.

21/10/2023:
NT scan 
NT: 1 mm 
Nasal bone seen 
Corpus luteal cyst seen.
A cystic lesion measuring 85x52x77mm with few internal septa within, noted in right adnexa, however right ovary could not be visualised separately.
Another cystic lesion measuring 57x38x40 mm with few internal septa within, noted in the left adnexa, however left ovary could not be visualised separately.
EDD: 26/04/2024

14/12/2024: TIFFA SCAN 
A cyst of size measuring approximately 96x52x113 mm noted in right adnexa showing thin septations within not showing vascularity on color Doppler -Right ovarian multiloculated cyst.

A cyst of size measuring approximately 54 x34x49 mm noted in left adnexa showing thin septations within not showing vascularity on color Doppler - left ovarian multiloculated cyst.
Single lie intrauterine gestation corresponding to 20 weeks and 5 days
AFW: 364 gms +/- 53 gm 

26/03/2024:
Growthscan Single live intrauterine pregnancy of36 weeks 5 days maturity Prominent fetal left renal pelvis Bilateral multiloculated ovarian cyst.(102x75 mm in rt adnexa ; 60x 37 mm noted in left adnexa)
https://drive.google.com/uc?export=view&id=1eglblFZqX7Fsh4ftGmehvnpilPLaFT-Ohttps://drive.google.com/uc?export=view&id=1RfLh2B_kJjU_83omITjIUTVauirby065https://drive.google.com/uc?export=view&id=1FZt8cCXajHW62jd1HGhP0O5jLbjfrDCIhttps://drive.google.com/uc?export=view&id=1KXauug_BGlzfuCP0mReFdgdhFyxORldDhttps://drive.google.com/uc?export=view&id=1VyrDf0mBvAMGdliFq9gJfMuNYq7N0paZhttps://drive.google.com/uc?export=view&id=1Tw8z0g1-KW-tWCYend6wuOVnmrjlAbT2https://drive.google.com/uc?export=view&id=1R9alOsJchP9XFobv8t_A8SNJcObhQbNmhttps://drive.google.com/uc?export=view&id=1G1F1W7rZ6bshoZURGbAcAYfPh4gxmXHdhttps://drive.google.com/uc?export=view&id=1XDZXefkOa9bEzqJdbg3nNa1I3lfuy92y









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