Reason for Consultation: 

In: Nursing

Reason for Consultation:   High-risk pregnancy with late-term bleeding. History of Present Illness:   Patient is a 23-year-old…

 

 

Reason for Consultation:   High-risk pregnancy with late-term bleeding.

History of Present Illness:   Patient is a 23-year-old female. She is currently estimated to be at 175 days of gestation. She has had a 23-lb weight gain with this pregnancy. Amniocenteses at 20 weeks indicated male fetus with no evidence of genetic or developmental disorders. She noticed a moderate degree of vaginal bleeding this morning but denies any cramping or pelvic pain. She immediately saw her obstetrician who referred her for high-risk evaluation.

Past Medical History:   This patient is multigravida but nullipara with three early miscarriages without obvious cause. She was diagnosed with cancer of the left ovary four years ago. It was treated with a left oophorectomy and chemotherapy. She continues to undergo full-body CT scan every six months, and there has been no evidence of metastasis since that time. Menarche was at age 13, and her menstrual history is significant for menorrhagia resulting in chronic anemia.

Results of Physical Exam:   Patient appears well nourished and abdominal girth appears consistent with length of gestation. She is understandably quite anxious regarding the sudden spotting. Pelvic ultrasound indicates placenta previa with placenta almost completely overlying cervix. However, there is no evidence of abruption placentae at this time. Fetal size estimate is consistent with 25 weeks of gestation. The fetus is turned head down, and the umbilical cord is not around the neck. The fetal heart tones are strong with a rate of 130 beats/minute. There is no evidence of cervical effacement or dilation at this time.

Recommendations:   Fetus appears to be developing well and in no distress at this time. The placenta appears to be well attached on ultrasound, but the bleeding is cause for concern. With the extremely low position of the placenta, this patient is at very high risk for abruption placentae when cervix begins effacement and dilation. She may require early delivery by cesarean section at that time. She will definitely require C-section at onset of labor. At this time, recommend bed rest with bathroom privileges. She is to return every other day for two weeks and every day after that for evaluation of cervix and fetal condition. She is to call immediately if she notes any further bleeding or change in activity level of the fetus.

1.   Describe in your own words the treatment this patient received for her ovarian cancer.

2.   Describe this patient’s menstrual history.

3.   This patient has placenta previa. What procedure discovered this condition?

4.   Define each medical term presented in bold type in the patient’s consultation report.

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