It is our pleasure to see and provide FTS for Ms. Jennifer Mullins. She is a 19yo, G1 P0, with EDD by an 8-week 1-day ultrasound performed in your office giving an EDD of 12/25/17. Her past medical history is notable for morbid obesity with a prepregnancy BMI of 45. She takes prenatal vitamins, denies any surgical history, is normotensive with a normal urine dip here. This is her 1st pregnancy. Her social history is negative x3. Her family history is notable for breast cancer, HTN, diabetes in her maternal grandmother, and heart disease in her as well. She has having occasional nausea, vomiting, and heartburn and says that the Diclegis is not working at all and would like a different prescription.
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.
Views today demonstrate a viable singleton fetus at 31 weeks 0 days in vertex presentation with an anterior placenta. Fetal biometry appears symmetric and corresponds with stated EDD falling at the 56%ile. Interval growth is noted; however, the growth percentage did trend down from the 80%ile to the 56%ile. Follow-up fetal anatomy visualized as normal or was previously documented as normal. Ductal velocity today measured at 69.2 cm/se, which falls within normal limits. AFI remains reassuring at 12.6 cm. BPP 8/8. Doppler studies are normal in value and wave form.
By dates, the patient is 35 5/7 weeks and the measurements are concordant. The amniotic fluid volume is normal. The fetus is in cephalic presentation. The BPP and Doppler studies are reassuring. A complete fetal anatomical survey was performed and no major malformations were noted at this time within the resolution of the ultrasound equipment other than the fetal abdomen. There is a cystic structure seen in the fetal abdomen that is about 3 cm in diameter with some echolucency surrounding this. It is below the kidney but above the fetal bladder as identified in your office.
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.
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.
A. 40 weeks and 2 days pregnant G1 T0 P0 A0 L0 (priority because of potential complications of pregnancy and labor, some which may be life threatening)
Ada is a 23yo, primigravida, who is currently 37 weeks 3 days. She is being followed in our office for weekly testing due to chronic HTN. Her last growth on November 30, 2017, was appropriate for gestational age. She is here today for antenatal testing and ongoing growth due of the possibility of delivery soon. She also has had polyhydramnios that at one point was up to 31 cm but at her visit last week it was stable at 26 cm. She had been evaluated for cholestasis but reports today that bile acids have returned negative.
We also rediscussed the AMA issue. She is not interested in the invasive and again CVS and amniocentesis were declined but she was interested in the noninvasive prenatal testing (NIPT) and now that she is beyond 10 weeks gestation that bloodwork was drawn. We will forward the results to your office upon return. In addition, because she did have a 36 week and 22 week loss, she would be a candidate for 17-alpha hydroxyprogesterone starting at around 16 to 187 weeks gestation. She actually was on 17-OHP with her last loss that occurred at around 20 weeks gestation.
Patient is a G1P0, 23-year-old Caucasian female patient, LMP is January 10, 2013, EDC is October 17, 2006 and gestation of 384/7 weeks confirmed by an ultrasound per chart. Pre-pregnancy weight was 110 lbs and pregnancy weight is 145 lbs for a total gain of 35 pounds. Patient stated she eats a normal diet, does not drink alcohol and she has never smoked cigarettes nor taken any kind of recreational drugs. Was admitted 0430 hrs on October 5, 2014 with intact membranes with 2cm dilation and 50% effaced. Birthing plan shows she plans on a natural birth, patient states “I plan on following my birthing plan to have no drugs during my labor, but am open to hearing my choices.” Patient plans on breastfeeding her infant for at least 1 year. Supportive husband was at bedside throughout the labor, delivery and postpartum.
PMH/PSH: My patient’s past history is sickle cell disease, hypothyroidism, hypertension, and obesity. My patient’s surgical history is a cesarean
Marisna is a 39yo, G3 P2002, who is currently 21 weeks 0 days as dated by LMP using a due date of 04/25/17. This was consistent with her 1st ultrasound in your office that measured just slightly ahead with a due date of 04/18/17. She is AMA. She had a quad screen in your office that returned screen positive with an increased risk of Down syndrome of 1:100. This is close to what her age based risk would be. Open neural tube defect was screen negative. In reviewing her analytes, AFP was slightly elevated at 2.15 MoM and inhibin was borderline at 1.87 MoM. She was diagnosed with chronic HTN fairly early in her last pregnancy. She did not have preeclampsia with that pregnancy to her knowledge. The baby was quite small, as it weighed just over 4 lb at term. She was not on BP medication chronically, but coming into this pregnancy at 19 weeks her BP was elevated at 162/90 and she was started on labetalol. I cannot tell in the records if she had protein in her urine but she did have 2+ on her dip in our office today. She reports that she has collected a 24-hr urine last week, although we do not have those results. Because she entered care late, she is not on baby aspirin for the prevention of preeclampsia.
On assessment fetal activity is normal, uterus is non-tender and in normal resting tone with no signs of contractions(Dains, Baumann
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.