Cesarean Delivery: A Case Study

She is without complaints. She has not noted any increase in preterm labor. No signs/symptoms or change in pelvic pressure. She is compliant with bedrest and has help taking care of her son. She is otherwise aware that she should discontinue Motrin next week and is aware of the signs/symptoms that we are monitoring. The placental cord insertion does appear marginal as noted on prior ultrasound and we are following monthly growth. She is aware that after surveillance of cervical length which will the last one we would anticipate would be next week at 32 weeks and after that we would still recommend monthly evaluation of fetal growth. Preterm labor precautions were reviewed. She is scheduled to return in one

Erin is a 33yo, G3 P1101, who was seen for an ultrasound evaluation and consultation. The patient has a longstanding past history of substance abuse as well as alcohol abuse and she is HIV positive with a positive viral load. She is followed by infectious disease and is on numerous medications including Genvoya and Prezista. She also is reportedly hepatitis C positive. She has a history of alcohol abuse in the past but states that she has not had any alcohol since early June. Her LMP was 08/06/17. She also has a history of cocaine usage but again denies any usage in the past year. She does have a longstanding history of physical abuse and has had issues with anxiety. She has 2 previous deliveries. The 1st of which was in 2004 that occurred

Brittany is a 22yo, G2 P1001, who was seen for an ultrasound evaluation and FTS. The patient states that she has a history of hypothyroidism but believes that she was tested in this pregnancy and told that her values were normal. I do not have copies of that lab work but would recommend that this be followed as her pregnancy progresses. She also reportedly has some issues with anxiety and IBS but is stable not on medication. She has a previous cesarean delivery with her last delivery but is uncertain about a VBAC. Lastly, she states that her main issue in this pregnancy is that when she wakes up in the morning after sleeping her arms and hands are numb or asleep and this did not occur in her previous pregnancy.

Keia is a 31yo, G2 P0100, who is currently 9 weeks 6 days as dated by a 6-week scan that was off from her LMP. She has a history of an IUFD at 29 weeks. She reports that she had decreased fetal movement prior to coming in and there being no fetal heart tones on examination, but other than that there were no other significant precipitating events. She did have an increased risk for Down syndrome at 1:140 but per the old reports all of her analytes were within normal limits. At the time of delivery, the baby did appear to be appropriate weight and there were no obvious causes at the time of delivery. She reports that she had chromosomes performed after and the chromosomes were negative. She also thinks she had a full autopsy that was unremarkable. She did have a work-up for clotting disorders due to the history of loss and according to the chart everything is relatively within normal limits except for MTHFR which was heterozygous for C677T and A1298C. I did not see beta-2 glycoprotein or antithrombin III. Because of the relatively normal work-up she is on a baby aspirin and Metanx. She is here today to discuss her history and plans for this pregnancy.

Catarina’s scan was overall reassuring Measurements were consistent with dates. I explained to her that amniotic

She reported having a normal delivery, full term with no complications; developed normally. Major events: none. Nutrition history: fair. Social history: Currently lives with 2 children in her mother’s house, separated with ex-husband, who is in jail and plans to get a divorce.

I was the nursing student assigned to Ms. K.R, an 18 year old African American female who was admitted to Detroit Hutzel labor and delivery unit on October 31st 2015. Upon admission Ms. K.R was 39 weeks and six days pregnant, in the first phase of latent labor, dilated to 3 cm, 70% effaced, -3 station and her contractions were four minutes apart. She had a history of asthma, bipolar depression, anxiety, elevated blood pressure and adult BMI of >30. She is allergic to penicillin, nuts, kiwi and blueberries.

Christine Le, an accountant living in Flushing, New York, gave birth to a healthy baby “Nathan” on January 29th, 2010. She found out that she was pregnant with her first child when her period was late. She had the routine prenatal care starting at 12 weeks and delivered at 40 weeks in a hospital with the present of her husband, Robert, and the in-laws. To insure her baby was healthy, Christine underwent several prenatal diagnostic methods like amniocentesis to examine for genetic defects. Another method was ultrasound; its purpose is to assess fetal age, multiple pregnancies, size and shape of the fetus. Christine underwent numerous lab tests to ensure that there are no complications (Berk, pg.43). Lab tests like a complete blood count that screens

Kecia is a 25yo, G3 P2002, who was seen for an ultrasound evaluation to evaluate the fetal abdomen. She overall denies any major medical disorders. She reportedly had a seizure related to an anesthesia event in a prior surgery but denies any history of epilepsy and therefore is not on an anticonvulsant. She has 2 previous term uncomplicated vaginal deliveries in 2012 and 2016. On today’s evaluation, overall, she has no obstetrical complaints and has positive fetal movement.

Anna is a 27yo, G2 P1001, who is currently 19 weeks 0 days as dated by LMP. She did have FTS that was screen negative. Her PAPP-A was somewhat low at 0.24 MoM. She has a prior child that was born with cystic fibrosis (CF). So far, the father of the baby has not been tested. However, he recently was placed on her insurance and will be able to be tested soon. She also hypothyroidism and is on a stable dose of levothyroxine bit has not had TSH testing for a couple of weeks. She is here today for her anatomic survey and evaluation of any markers for possible CF.

Views today demonstrate a viable singleton fetus at 12 weeks 2 days. Fetal crown-rump length measures 59.2 mm. The best nuchal translucency measurement obtained was 1.8 mm, and the nasal bone was visualized as present. Fetal cardiac activity is visualized. Due to early gestational age, fetal anatomy was not assessed, but 4 extremities are noted. Amniotic fluid and placental location are visualized as normal within limitations of early gestational age. Adnexa are suboptimally seen. No notching is seen on the uterine artery Doppler’s.

Thank you for the opportunity to participate in the care of Ms. Stansberry, who as you know is a 15yo female, G1 P0, currently at 26 weeks 0 days EGA with a pregnancy complicated by late establishment of PNC and maternal obesity.

Rachel is a 32yo, G7 P3033, who is currently 18 weeks 1 day. She is dated by LMP. She was seen previously for a dating scan and declined aneuploidy screening. She has 3 prior full-term deliveries. She had preterm labor with her last pregnancy but ultimately delivered at term. While she has miscarriages, she does not have 3 in a row. She is here today for an anatomic survey.

On ultrasound, there is a live fetus in breech presentation. Fetal biometry is symmetric and consistent with dates. A detailed anatomic survey was overall unremarkable but we were unable to adequately obtain fetal cardiac views in order to complete the echocardiogram. Both myself and the sonographer scanned and unfortunately the fetus remained in the spine up position after an extended amount of