Maria is a 35yo, G3 P2002, who is reportedly 13 weeks 5 days by LMP but appeared much larger on physical exam. She is here today for dating and anatomy. She has a history of chronic HTN and was on HCTZ but stopped about 2-3 months prior to pregnancy. She is obese with a BMI of 38. She has 2 prior full-term deliveries without complications.
On ultrasound there is a live fetus whose biometry is consistent with 20 weeks 5 days. A detailed anatomic survey was unremarkable but spine and RVOT were suboptimal. The placenta is posterior. Abdominal cervical length is reassuring.
Maria’s scan was overall reassuring. We spent today discussing several issues:
1. We discussed dating. I dated her based on today’s scan but we will follow-up in 3 weeks to confirm dates.
2.
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We also discussed anatomy. We will need to complete spine and heart views at that follow-up scan.
3. We also discussed her chronic HTN and the fact that with normal BP’s often in pregnancy we do not require treatment; however, if her BP’s were to elevate we may need to restart medication at some point.
4. It was too late start a baby aspirin for the prevention of preeclampsia but we will go ahead and follow growth scans and consider antenatal testing if needed.
5. Finally, in regard to AMA, we did a quad screen since anatomy was within normal limits and there was no aneuploidy.
We will also continue to follow growth for multiple reasons. She is scheduled to return in 4 weeks.
Thank you for referring this patient to our office. Please do not hesitate to call us if you have any questions.
THIS REPORT HAS BEEN DICTATED BUT NOT EDITED
Lynlee Wolfe, M.D.
Maternal-Fetal
On Exam: BP today was 140/86. Head and neck exam was all clear. She had no oral or nasal ulcers. She had no lymphadenopathy or bruits. Heart sounds were normal and the chest seemed clear, as did the abdominal exam. Musculoskeletal exam disclosed widespread Heberden's and Bouchard's nodes. She had no swelling or stress pain at the MCPs. She was not tender at the CMC joints. She had no swelling in the wrist, elbows or shoulders. She had no soft tissue tender points. She has bilateral knee crepitus but only slight instability and no effusions. She had actually good range of movement of both hips. She was tender in the lumber spine and has a scar at the lower lumbar spine from her previous operations. Her feet are somewhat flat with tenderness across 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.
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.
Afton is a 31yo, primigravida, who is currently 23 weeks 6 days. She has type 2 diabetes but her A1C coming into pregnancy was just under 6. A recent A1C in June was 6.1. She is currently on insulin with Levemir and NovoLog. She also has chronic HTN and takes labetalol. She is on a baby aspirin for preeclampsia prevention. She has been following in our perinatal diabetes program and we have made some adjustments. Because of her type 2 diabetes she is here today for a fetal ECHO.
After her blood work came back clear, the physician ordered an EEG and CT-scan to get an in-depth view
Lynn K. is a 31-year-old Caucasian female G1P0 presents at 25 wga for a prenatal visit. She does not take her prenatal vitamins every day because they make her feel very nauseous and has experienced morning sickness throughout her pregnancy. She states that she feels fatigued very easily and describes feeling short of breath when carrying out simple tasks around the house. She began feeling this way approximately four weeks ago, and attributed it to “normal pregnancy symptoms.” Recently, she began noticing occasional lightheadedness and dizziness. The patient’s history indicates that she has suffered heavy periods prior to her pregnancy.
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.
She is available next Wednesday (3/30) for a lunch so would like to extend the invitation to you all.
SEIDAL, H, M., BALL, J, W., DAINS, J, E., BENEDICT, G, W. (2006) Mosby’s Guide to Physical Examination. 6th edn. Philadelphia: Elsevier.
By dates, she is 19 1/7 weeks and the fetal measurements overall are concordant at about 3-4 days smaller. The amniotic fluid volume is normal and the cervix is long and closed with no evidence of membrane funneling. The placenta is anterior and is not low-lying. It is possible that the edge of the placenta extends down to where the old cesarean section scar would be located but there is no increased vascularity at this point in time. A complete fetal anatomical survey was performed and no major/minor malformations were noted at this time within the resolution of the ultrasound equipment.
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
However, she has a low grade fever of 101 Fahrenheit. She is normal weight. She weighs 130 pounds with a body mass index (BMI) of 21.6.
My prenatal development was normal. There were not any concerns or worries about my development. My mom had a fairly normal pregnancy other than preeclampsia. Preeclampsia is a medical condition in women who have not experienced high blood pressure, and developed in during a pregnancy (Preeclampsia and Eclampsia, 2016). High protein levels in urine and swelling of the hands, legs and feet are other symptoms of preeclampsia. My mom had an ultrasound at fourteen weeks. She did not have any other testing like an amniocentesis or chorionic villus sampling. It was unnecessary.
Based on this new information, what is your diagnosis for this patient? Has your diagnosis changed? (2 pts.)
Twenty minutes passed and the cat scan was over. They said that my mom and my brother had to wait an hour until they got the results back. So they waited.