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Female patient, 23 years old, 3 month pregnant, came to the clinic complaining that

she had felt congested all the time, always had a runny nose, sneezing, and nasal

itching since 1 month ago.

1. Identity

Name : Mrs.Sugeng

Age : 23 years old

Weight : 55 kgs

Occupation : Housewife

Address : Jln. Selabintana no. 9, Sukabumi.

2. History

Chief complaint : Patient complaining that she felt congested all the time

since 1 month

ago.

Additional complaint : Patient also complaining that she always had a

runny nose, sneezing

nasal itching sometimes headache. Patient was difficultto sleep and breath comfortably.

History of present illness :

One month before coming to the clinic, patient complaining that she

had felt congested all the time,there was no differences in the morning,

afternoon or in the night. She also complaining of having runny- nose, large

in volume, watery clear. Followed with nasal itching, sneezing and

sometimes headache associated with the nasal congestion.

The patient found that she was difficult to sleep and breathcomfortably, because her nose was clogged up and It was getting worst when

she was laid down, followed with snoring. But it was getting better when she

was slept with the head propped up on a pillow. Because the difficulty in

breathing through the nose, the patient usually use mouth breathing and her

mouth was dry.

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There is no fever found, there is no history of allergy of food, dust,

dust mite, pollen or drug allergy before and during pregnancy. There is no

history of asthma in family or in patient.

3. Physical Examination

Right ear : Outer ear Auricle : normal

CAE : normal

Tymphanic membrane : intact, light reflex

+

Left ear : Outer ear Auricle : normal

CAE : normal

Tymphanic membrane : intact, light reflex

+

Nose : Outer nose Shape: symmetrical, edema

Nasal bone : deviation -, depression

Palpation : crepitation -, tenderness +

Ant rhinoscopy Vestibulum : normal

Septum : normal

Inferior conchae : hypertrophy

Mucous membrane : hyperemic, secretion +/

+

( large in volume, watery-clear, no smell)

Mouth : Pharynx Non- hyperemic

Tonsil T1-T1, non hyperemic

Neck : Enlarged lymph nodes

4. Working Diagnosis

Rhinitis during pregnancy

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5. Differential Diagnosis

a. Chronic rhinitis

b. Vasomotor rhinitis

c. Allergic rhinitis

6. Laboratory and imaging

RAST (Radioallergosorbent Test) / Ig E specific blood testing

7. Therapy

a. Normal saline irrigation

b. Anti histamine : chlorpheniramine tab 4 mg 3 dd 1.

c. Oral decongestant : phenylpropanolamine 50 mg, 2 dd 1.

8. Education to the patient

The best treatment for pregnancy rhinitis symptoms is often self

care. Here are some things that we can tell the patients to do at home

to relieve the patients discomfort:

Drinks lots of fluid, especially water. Avoid caffeinatedbeverages, as these can be dehydrating.

Avoid environmental irritants, like cigarette smoke.

Sleep with the head propped up on a pillow.

Exercise in moderation. Easy exercise can actually help to

reduce nasal congestion.