Shannon is a 35-year-old African American married woman.
History of Present Illness: presents to the office with private insurance with a chief complaint of amenorrhea for 6 weeks. Denies headache, edema, vaginal bleeding or discharge. Patient does have nausea and vomiting for the last week that occurs three times a day. UCG done at home one week ago was positive. Negative urine protein, glucose and nitrates.
In this module, you will review Shannon’s record and complete the risk assessment table based on the information you have about your patient at her 6 week initial prenatal visit. Include the appropriate testing for this patient, patient education, anticipatory guidance and treatment options if needed. (All of the information above should be included in this module)
In this module, you will review Shannon’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.
7 week prenatal visit
Shannon returns to the office 1 week later, when she presents with vaginal bleeding x 3 hours, pt. states bleeding started this am, when she got up to go to the bathroom. She reports the bleeding as red, light to moderate in amount. No pain or cramping noted. Weight was 256 lbs. B/P 120/70, negative urine protein, glucose and nitrates; no headache, nausea, vomiting, no edema, vaginal discharge; patient is taking her vitamins.
In this module, you will review Shannon’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.
29 week prenatal visit
Shannon returns for her routine prenatal visit at 29 weeks. Since treating her thyroid condition, she has no further bleeding and the pregnancy has been uneventful. Wgt 254, B/P 122/76, urine is 2+ glucose, trace protein, negative ketones. Shannon indicates that she feels the baby move every day, no leaking, bleeding or contractions. She is taking her PNV qd along with the levoxyl 0.25mg. Shannon indicates that she has some white clumpy vaginal discharge that is very itchy, for the past few days. No odor or burning. Fetal heart is 160, Fundal height is 31 cm
Laboratory: NIPT was normal, AFP 1.60 MoM, Her TSH last visit was 2.4, CBC at 16 weeks was normal, one hour gtt today was 167.
US: Her sequential screen from earlier in the pregnancy is normal.
Fetal Survey at 20 weeks was normal.
In this module, you will review Shannon’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.
33 week prenatal visit
Shannon returns for a routine prenatal visit at 33 weeks. Wgt is 256, B/P 128/80, FHR is 164 and Fundal height is 36 cm. Shannon indicates she feels the baby move every day and performs her kick counts daily. She is taking her PNV and Levoxyl as ordered. She completed the monistat given a few weeks ago, and has no further symptoms. Shannon had an elevated 1 Hour at her 29 week visit and had a 3 hour gtt. Shannon met with the diabetic educator and endocrinologist and was started on NPH 5 units TID. She is doing home blood glucose sticks with a goal of FBS < 90 and 2 hour postprandial of < 120.
Laboratory: 3 hour gtt- FBS 98, 1 hour-164, 2 hour-160, 3 hour 135.
US: Cephalic position, EFW 2812 gr (90%), AFI 21 cm. Posterior fundal grade 2 placenta, 3 vessel cord.