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.
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, lotion, 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 striae and erythematous 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.
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.
US: Her 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.