Karina is a 29-year- old Caucasian female, Gravida 4, Para 0303. She’s a single mother and has state funded health insurance.
3 years ago: 32 week | C/S-abruption | Male 4 lbs. | no sequelae |
2 years ago: 24 weeks | Preterm Labor SVD-VBAC | Male 2 lbs. 2 oz. | child is blind |
1 year ago: 26 weeks | Preterm labor C/S Fetal Dist. | Female 2 lbs. 13 oz. | no sequelae |
Social: ETOH none, tobacco 4 cigs/day; marijuana 1 joint a day, no other substances. She lives with her three kids and works at Dunkin’ Donuts about 30 hours a week.
In this module, you will review Karina’s record and complete the risk assessment table based on the information you have about your patient at her 8 week initial prenatal visit. Include the appropriate testing for this patient, patient education, anticipatory guidance and treatment options if needed.
In this module, you will review Karina’s prenatal visit. Using the risk assessment table please identify any new risks and include the appropriate testing for this patient, patient education, anticipatory guidance and treatment options, if needed, for current or previous risks and routine matters.
20 week Prenatal Visit
Karina returns for her 20 week prenatal visit. Her blood pressure is 120/50. She weighs 136 lbs. Fetal heart tones are 139 bpm (beats per minute). Karina’s fundus is at the umbilicus. Urine dip is negative for protein, ketones and glucose. She reports painless vaginal spotting for one week and no contractions. She reports quickening since 16 weeks. Patient has stopped smoking with the help of her boyfriend. Karina’s sequential screen is negative.
Laboratory: CBC HGB: 11.2, HCT: 36.2, PLT 189,000.
US: The result of Karina’s 20 week USD: HC/AC consistent with 20 week gestation, EFW 266 grams, amniotic fluid volume normal, 3 vessel cord, vertex position, anterior partial previa, grade 0, cervix 3.6 cm, no funneling.
In this module, you will review Karina’s prenatal visit. Using the risk assessment table please identify any new risks and include the appropriate testing for this patient, patient education, anticipatory guidance and treatment options, if needed, for current or previous risks and routine matters.
28 week prenatal visit
Karina returns to the clinic at 28 weeks. Karina’s blood pressure is 124/50. She weighs 142 lbs. Fetal heart tones 135 bpm. Fundal exam measures 28 cm. She reports intermittent vaginal bleeding, no discharge and mild inconsistent contractions. She complains that her belly has been itching daily for two weeks. She denies any new use of creams, lotions, perfumes, or laundry detergent. She has not started any new medications or tried any new food. She states her skin is becoming more and more itchy that it is driving her crazy.
PE: Abdomen evident for straie and erythemetic plaques with a pale halo around the plaques. Has a slight hive like appearance. No pustules, no exudate, no ulcerations, crosses midline.
Laboratory: LFT’s normal, Uric Acid normal, Amylase normal.
In this module, you will review Karina’s prenatal visit. Using the risk assessment table please identify any new risks and include the appropriate testing for this patient, patient education, anticipatory guidance and treatment options, if needed, for current or previous risks and routine matters.
35 week prenatal visit
Karina presents to clinic at 35 weeks. Karina drives from her place of work to clinic. Her blood pressure is 95/40. She weighs 154 lbs. Fetal heart tones are 125 bpm. Her fundus is rigid, tender and measures at 35 cm. She reports decreased fetal movement for 8 hours. Karina has been filling a pad every hour for 8 hours while at work and the blood is bright red. Pt states she got into a physical fight with boyfriend today and her sister kicked her in the abdomen.
Labs: 1 hour gtt done at 28 weeks 109, CBC normal at 28 weeks; Kleihauer Betke 0.9% fetal cells 45 cc.
Usher 28 week US showed HC/AC consistent with 28 4/7 weeks gestation, EFW 1257 gr (57%), 3 vessel cord, marginal insertion, anterior grade low lying placenta, amniotic fluid index 16 cm, cervix 3.3 cm, no funneling, breech position.