Krystal Case Studies

Breasts: no masses, no nipple retraction, no discharge. Heart: S1 and S2, no gallops, rubs, or murmurs appreciated. Abdomen is scaphoid, soft and non-tender with positive bubble sounds. Pelvic/ Rectal: deferred as patient has recently visited her GYN for a routine Pap smear. Neurologic exam reveals normal motor strength in all muscle

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

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.

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.

Keziah is a 4 month old female with hx of complete AVC s/p surgical repair on 10/03/17. She is currently in heomdynamically stable junctional ectopic tachycardiac which is commonly enocuntered problem in the first few days after cardiac surgery.

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.

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.

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

On today’s ultrasound, a single living IUP is identified with the fetus currently in cephalic presentation with a 3-vessel cord with normal insertion into an anterior right-sided placenta. Fetal biometry today demonstrates an EFW at the 31%ile for reported gestational age. A detailed anatomic survey is without any notable structural abnormalities; however, portions of the fetal face and heart remain to be well visualized due to the fetal position. There was some concern on outside ultrasound for possible cervical shortening and due to this a transvaginal ultrasound was performed that

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

On ultrasound today there is a live fetus whose crown-rump length is consistent with prior ultrasound dating. The nuchal translucency measured 2.1 mm, and a nasal bone was present. There was normal ductus venosus flow.

She had an 8-week ultrasound that confirmed her dates. She now is 11 ½ weeks and is interested in a FTS. The nuchal translucency measurement fell within the normal range. The nasal bone was identified, and there was normal ductus flow. She therefore underwent laboratory testing and the complete result of this screen should be available in the next 4-7 days. If the result of this screen returns with decreased risks, we would recommend a good fetal anatomical survey between 18-22 weeks gestation.

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

Jessica is a 29yo, G4 P1021, who was seen for an ultrasound evaluation and possible FTS. She overall denies any major medical disorders other than she does have some issues with depression but is currently not on treatment and states that she is doing okay currently. Obstetrically, she has one previous 36-week delivery in 2012. She was induced for what sounds like preeclampsia. She does not recall whether or not her BP was elevated but she had some liver dysfunction and some kidney dysfunction and the fetus was growth restricted at 3 lb 9 oz. It did stay in the NICU for about 30 days. However, again this was an induced preterm delivery and therefore she would not be a candidate for 17-OHP. Currently at this time she has no complaints.

Delievery CS. color is pink with olive undertones, good cry, head normocephalic, fontanelles and sutures WNL. Milia present across nose. Hair is soft, black and sparse. Eyebrows and lashes present, eyes and ears level, nostrils equal, no flaring observed. Sucking pads present. Palate intact, good suck reflex. Eyes bright dark brown, + blink reflex, baby is responsive to sound and movement. Scelera bluish-white. Ears are symmetrical, well-formed. No lesions noted. Clavicles straight and intact. BL lung expansion, Lungs clear BL, no murmurs or thrills noted. Abdomen protruding, umbilical cord dry, no bleeding. Active bowel sounds x 4 quad. No inguinal bulges, femoral pulses +1/4. Buttocks symmetric, anus patent, no dimpling at coccyx. Symmetric