Yananari 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

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.

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.

Serrita is a 26yo, G3 P1011, who was seen for an ultrasound evaluation and fetal anatomy assessment. As you know, she has chronic HTN and is on methyldopa 500 mg b.i.d. Her BP is normal on today’s assessment at 130/78. Her urine evaluation was negative. She is also hypothyroid status-post a diagnosis of Hashimoto’s thyroiditis. She is on replacement therapy. She did undergo noninvasive prenatal testing (NIPT) that returned low-risk, female and her maternal serum AFP was normal at 0.58 MoM. Based on her height and weight at the start of the pregnancy, her BMI was about 38. Lastly, she is on metformin 500 mg b.i.d. She states that she believes that she was on this due to abnormal insulin levels but she was not completely certain as to why

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

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.

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.

On ultrasound there is a live fetus in cephalic presentation. Fetal biometry is consistent with dates. On detailed survey we did note an ONTD that is suspected to be from the lumbar down to the sacral area. There was no skin covering the area and there was no clear evidence of meningomyocele but on transverse imaging of the spine they are significantly splayed. In the intracranial views we did see a lemon and banana sign. The ventricles were upper-normal and prominent, right at 1 cm with dangling choroids.

Currently, the patient suffers from seasonal allergies and recurrent otitis media. He subsequently received PE tubes in 2013 and has had no further complications. His father has hypertension and hypercholesterolemia and is age 30. His mother reports suffering from seasonal allergies. His father has one brother who has hypertension and one sister who has a negative medical history. His mother has two brothers, both of whom have hypertension. The child’s paternal grandfather has hypertension and hypercholesterolemia. His paternal grandmother has hypertension and diabetes mellitus (type 2). His maternal grandparents both have hypertension. Currently, his mother is pregnant and is to have a daughter.

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

Angela is a 36yo, G5 P3013, who was seen for an ultrasound evaluation and consultation for AMA. The patient is currently 36 but would be 37 at the time of her EDD. She does have a history of chronic HTN and reportedly is on labetalol 100 mg b.i.d. but in talking to her she has actually not filled the prescription yet and therefore has not started the medication. Her BP was 141/98 on her initial check and on repeat 140/92. Her urine evaluation is negative for protein. She does have asthma but is currently asymptomatic. Based on her height and weight at the start of the pregnancy, her BMI was 44. She also does smoke cigarettes at ½ pack per day. She was counseled on cessation.

On ultrasound there is a live fetus in cephalic presentation. Fetal biometry is consistent with dates. A limited survey was unremarkable. Fluid and Doppler’s are overall reassuring and BPP is 8/8.

R/s Ja’Niyah (11-months-old) has rectal bleeding. R/s on yesterday Breanna had to pick Ja’Niyah up from daycare because the child was bleeding from her rectum. R/s Breanna did take the child the ER at Tuomey. R/s according Breanna the doctor gave her the option to have the baby admitted or released. R/s the baby was released last night. R/s as of today the baby has not had any medical follow-up. R/s Breanna is expecting and her due date is 07/30/2015.

By dates she is 37 ½ weeks and the measurements overall are concordant with an EFW at around the 50%ile. The amniotic fluid volume is normal with an AFI of about 11 cm. The BPP is 8/8 and the Doppler study is reassuring.