Resident Obstetrical Clinic Case Summary

G4 P3003 (4 Gestations, 3 Full Term, 0 Preterm, 0 Miscarriages, 3 Currently Living); 3 Spontaneous Vaginal Deliveries; Last birth was 7 years ago by SVD, weighed 4000 grams; No previous obstetrical complications or morbidity; No past medical history; No past surgical history; No prior antenatal care

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.

I planned on stopping by today to speak with you; however, I wanted to give you a heads up first to think about it. Friday, Jennifer’s water ruptured very early(33 weeks). We had to go to the hospital where they have to keep her until the baby is born. They are trying to keep her from having the baby by utilizing different methods of medication for at least another week so the baby can develop his lungs. However, they are going to try and keep the baby in longer if possible. The baby will go directly into a NICU because it is too early unless they can keep the baby in past 35 weeks and he is developed enough to eat and breath on his own. I highly doubt that Jennifer will be able to start on the starting date June 3rd. Today, when our doctor

Multiple antenatal, antepartum, and postpartum challenges are incurred with a BMI of > 45. Miscarriage is at an increased risk among women with elevated BMI as well as prevalence of GDM and preexisting diabetes. First trimester screening for previously unrecognized diabetes with an early glucose screening is recommended. Obese women have an increased risk for hypertensive disorders as well as preeclampsia. It is not clear whether low-dose aspirin therapy is effective in reducing the likelihood of developing preeclampsia among women with an elevated BMI; however, low-dose aspirin is low-risk and therefore, can help decrease the risk for preeclampsia among women with moderate to high risk of developing the disease. Obstructive sleep apnea may be precipitated or exacerbated during pregnancy and may increase the risk of preeclampsia and GDM. Women who are obese have an increased risk for preterm birth. Maternal obesity is also associated with an increase in absolute rate of congenital anomalies. In addition, congenital anomalies are often more difficult to detect by prenatal ultrasound given acoustic limitations. (Detection decreases by 20%) Finally, there is an increased risk of dysfunctional labor in addition to complications that are incurred should an operative delivery be required. Weight gain goals recommended in obesity are 10-15 lb. Unfortunately, weight loss during pregnancy is not recommended. Serial surveillance

Because her initial pregnancy was preterm based on PPROM, she would be a candidate for 17-OHP and this was discussed and would recommend that this start at around 16-18 weeks gestation. In addition, because of her prior history of cesarean deliveries as well as her HIV status the plan will be to undergo a repeat cesarean in this pregnancy at around 38 weeks gestation and she does have good dates. She does have a follow-up appointment in your office in 3-4 weeks.

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.

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

“Sefa’s had what we call a grade two placental abruption, which means the placenta has become slightly detached from the uterine wall. Sefa and the baby are fine for the moment, but since the baby’s already full-term, I don’t want to take any chances. Sefa’s agreed to a C-section, which I feel is the best and safest course of action. But it needs to happen immediately.”

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.

Jace Sauseda Clinical Rotation Mrs. Ysaguirre 17 November 2015 NICU Clinical Report At the Neonatal Intensive Care Unit doctors, nurses, and all staff unite together with one primary goal for each new life they receive, that goal being to achieve the best outcome for each premature and critically ill baby. The NICU, at University Hospital, care for 600 infants annually. Inside is a 58-bed facility, offering the highest level care led by on-site neonatologist (University Health system). The (NICU) is specialized to care for premature infants (those less than 37 weeks gestation) as well as sick newborns.

The main purpose of this assessment is to guarantee a healthy baby, with low risk to Angie’s health. At present Angie weigh’s 177.5 lbs. and her height is 5’5”, this puts her BMI at 30 she is classified as being obese (Grosvenor & Smolin, 2015, p. 292). She is currently experiencing some complications at this stage in her pregnancy. Additionally she desires to keep her weight in line with the recommended weight gain guidelines for pregnant women which are about 11-20 lbs., during her entire nine months of pregnancy (Grosvenor & Smolin, 2015, p. 369).

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

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

This is regarding your grievance against your medical group, Angeles IPA regarding network access. In your grievance it was indicated that you preferred a female Obstetrician (OB/GYN) and would prefer Downey Presbyterian Hospital to deliver.

She has an appointment scheduled with Dr. Wilcox on Wednesday for the glucose test. She will have a C-section due to her baby being