Housestaff Resident Obstetrical Clinic Case Study

This week of maternity clinical rotation, I had a patient Mrs. M was 35-year-old G2P2. She gave birth to a boy by cesarean section at 41 weeks. Mrs. M had Rh+ and Blood group was O+. She was rubella immune, +PPD and had no known allergies. Her GBS, HBsAg, and RPR status were negative.

During our initial assessment of Ms. K.R., the following vital signs were noted: blood pressure was 147/67, temp 36.6 degrees Celsius, pulse 80 beats per min., respiratory rate of 20, pulse ox 99% on room air, a pain score of 8 during contractions, and fetal heart tones had a baseline of 130 over the last two hours. Her labs showed 2+ protein in her urine but she denied any headaches, vision changes, right upper quadrant pain, and no DTRs or colonus were observed. Ms.K.R. seemed to be handling her labor well, with the exception of being in a lot of pain and unable to find a comfortable position.

On today’s evaluation, she is 13 6/7 weeks and the crown-rump length measurement is concordant. The nuchal translucency measurement fell within the normal range. The nasal bone was identified, and there was normal ductus flow.

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.

On today’s evaluation, she is 19 weeks and the fetal measurements overall are concordant. The long bone measurements are within one week of her dates. The amniotic fluid volume is normal, and the cervix is long and closed. A complete fetal anatomical survey was performed and a significant amount of ventriculomegaly/hydrocephalous was identified but no other major malformations were noted at this time, though due to the

Thank you for the opportunity to participate in the care of Ms. Megan Robertson, who as you know is a 20yo female, G2 P0101, currently at 16 weeks 5 days EGA with a pregnancy complicated by a history of prior spontaneous preterm delivery at 35 weeks of gestation and maternal underweight status. She presents today for evaluation of cervical length and fetal growth due to her history of prior preterm delivery and started her course of 17-alpha hydroxyprogesterone caproate injections today and these are weekly injections for her to reduce the risk of preterm birth secondary to her history of prior spontaneous birth.

Joanne and Steve wanted a C-section as they had difficultly delivery with their first child; however Joanne went into labour early. The baby was delivered 3 days before the C-section was scheduled. With her first child she was given an epidural that did not work, this is why she had requested the C-section for the birth of this child. Their first child died at 21 days old, he was an IVF baby and it had taken them 5-6 years to get him. After a couple of years they started trying for another baby, they had been saving up for more IVF but they managed to conceive naturally. They had more scans during this pregnancy to ensure the health of the baby was okay.

This particular case study involves a 29 year old obstetric patient who presented to the labor and delivery unit at 33 weeks gestation with complaints of abdominal pain for the past three days that had become more severe and absence of fetal movement noted since the previous evening. Her obstetric history revealed she has one living child and has had one previous miscarriage at ten weeks

Coding for this instance to include a diagnosis made-up of the live-born status, delivery method, and place of birth.

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

By dates, she is 20 5/7 weeks and the measurements are concordant. The amniotic fluid volume is normal, and the cervix is long and closed with no evidence of membrane funneling. A complete fetal anatomical survey was performed and no major malformations were noted at this time within the resolution of the ultrasound equipment.

By dates using an EDD of 05/02/17, she is 14 3/7 weeks. The fetal measurements on average are about 9-10 days larger and are symmetrical. The amniotic fluid volume is normal and the cervix appears to be long and closed. There is an anterior LUS fibroid that is about 2 ½ cm in size. A fetal anatomy assessment was performed though limited by the early gestational age. No major malformations were

Manisha’s scan was fairly reassuring. Her amniotic fluid, while < 5 cm, is actually stable over the last week. She reports excellent fetal movement. I placed her on NST which was reactive with no decelerations. I was very pleased with her interval growth and because of this, I have allowed her to continue outpatient management. We will continue to see her on Mondays/Wednesdays/Fridays for BPP and AFI. I would also like to obtain NSTs on Mondays and Fridays to assure that we are not missing anything given her low fluid. As long as she has an AFI above 5 cm or a 2 x 2 cm pocket we should try to continue to at least until her next growth scan in 2 weeks. After 34 weeks, we can reevaluate our delivery plan.

U/S: Viable fetus 16 5/7 weeks, EDC November 11, 2010, limited survey, posterior placenta, not previa.

On ultrasound there is a live fetus whose biometry is slightly behind dates. Measurements are fairly symmetric, although the abdomen lags just slightly. Measurements are about 2 weeks behind dates with growth < 3%ile. A limited survey was overall unremarkable as noted above. Umbilical artery Doppler’s as well as MCA Doppler’s were within normal limits. Amniotic fluid was normal, and BPP was 8/8.