OBhiriskcon Caraan Updated

8/3/2019 OBhiriskcon Caraan Updated

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S E P T E M B E R 2 7 , 2 0 0 8

High Risk Conference


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M.B.C.

25 y/o, G1P0

24-25 wks AOG

Chief Complaint

Hypogastric pain


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History of Present Illness

Hypogastric pain radiating tothe lumbosacral area

No passage of blood or watery

vaginal discharge Consult with an OB

Abdominal exam: (+) uterinecontractions

IE: cervix soft, short, closed

P> advised admission

Isoxsuprine HCl drip started

Two days PTA


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Intermittent hypogastric pains

Pelvic UTZ1 day PTA


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Impression

Single , live, intrauterine pregnancy, cephalic, 25weeks AOG, w/ good cardiac & somatic activity;Cervical funneling (0.85cm)


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Betamethasone 12mg/IM x 2doses, 24 hours apart

P> for cerclage

Transfer to USTH-CD

1 day PTA

ADMISSION


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PrenatalCheck-ups

Prenatal check up at USTH-MAB, ~3x

1st at 5 mos AOG (8/22/08)

Fetal biometrySingle, live, intrauterine pregnancy of about 20-

21 weeks AOG w/ good cardiac & somaticactivity

CBC- NormalUrinalysis: (+) UTI Cefuroxime 500 mg

BID x 7 days


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Oral Glucose Tolerance Test

FBS 66.8 mg/dl

1st hr 145.0 mg/dl

2nd hr 110.0 mg/dl

3rd hr 112.0 mg/dl


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No anorexia, weight loss

No fever

No cough

No hearing loss, nasal congestion

No polyuria, polydipsia, polyphagia

No cyanosis

No chest pain No diarrhea, no constipation

No dysuria, incontinence

Review of Systems


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Social smoker (5 sticks/occasion)

Drinks alcohol occasionally (2x in 6 months; 10shot glasses of brandy)

Denies illicit drug use and abuse

Personal and Social History


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No diabetes mellitus

No hypertension

No heart disease

No thyroid disease

No bronchial asthma

No allergiesNo previous hospitalization

No previous surgeries

Past Medical History


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(+) Diabetes Mellitus - mother

(+) Thyroid disease mother

(+) Hypertension father

(+) Cancer, prostate

maternal grandfather No heart disease

Family History


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Menarche 13 years old

Interval 60-90 days

Duration 7 days

Amount 4-5 pads per day, moderatelysoaked

(+) D1 & D2 Dysmenorrhea

Menstrual History


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Conscious, coherent BP 110/80 PR 80 RR 19 T 36.5 Ht 150 cm Wt 52 kg

Warm, moist skin; no active dermatoses Pink palpebral conjunctivae, anicteric sclerae Neck not rigid, no palpable lymph nodes, thyroid

not enlarged

Symmetrical breasts, no palpable masses nortenderness, no nipple discharge, no axillarylymphadenopathy

Physical Examination


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Adynamic precordium, AB at the 5th LICS, MCL,No murmurs

Symmetric chest expansion, no retractions, clearbreath sounds

Globular abdomen, FH 24 cm, FHT 142 bpm Speculum Exam: cervix violaceous, smooth, w/

minimal whitish mucoid discharge

IE: cervix: soft, short, closed

uterus: enlarged to 6 months

Extremities: pulses full and equal, no cyanosis, noedema

Physical Examination


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Pregnancy 24-25 weeks AOG,threatened preterm labor

Assessment


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Hemoglobin 99

Hematocrit 0.28WBC 14.5

Segmenters 0.89

Lymphocytes 0.11Platelet 300

LaboratoryTests

CBC


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Color yellow

Transparency Sl. turbid

Ph 7.0Specific gravity 1.010

Albumin NEGATIVE

sugar NEGATIVE

RBC 0-1/hpf

Pus cell 3-5/hpf

Squamous cell ++

Bacteria FEW

Mucus threads FEW

Amorphous urate +++

LaboratoryTests

Urinalysis (9/8/08)


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Problem #1: Pregnancy 24-25 weeks,threatened preterm labor

1. Complete bed rest, no bathroom

privileges

2. Continue tocolysis - 4 ampulesIsoxsuprine HCl in 500cc D5W to run at

20ugtts/min to titrate at increments of 5ugtts/ min

3. For cerclage

Plans


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Continue multivitamins OD

Continue FeSO4 OD

Continue milk, 1 glass OD


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Course in the Ward


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S> Good fetal movement

No hypogastric pains

No bloody or watery vaginal discharge

O>BP 110/80 PR 84 RR 18 T 36.5

FHT 148 bpm

No uterine contractions

P> Continue IV Tocolysis

1stHD: 9/25/08


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O> BP 110/80 PR 72 RR 19 T 36.6

FHT 146 bpm

P> Continue IV tocolysis

Cerclage done

2nd HD: 9/26/08


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3rd HD: 9/27/08




O> BP 120/70 PR 76 RR 19 T 36.5

FHT 143 bpm



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4th HD: 9/28/08


No uterine contractions


O> BP 120/80 PR 80 RR 18 T 36.6

FHT 151 bpm


Start Isoxilan HCl 10 mg/tab, 1 tab q8 hrs

For cervical length & funneling determination


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5th HD: 9/29/08


No hypogastric pain/uterine contractions


O> BP 120/80 PR 88 RR 18 T 36.8

FHT 145 bpm

P> Continue Isoxilan tablet q 8 hrs


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Cervical length and funneling determination


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Impression

Funnel length

1.60 cm

NARROW BUT DEEP UFUNNEL

Functional cervical length 1.72 cm

Hyperechoic foci 1.2 cm from the external os(sutures)


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6th HD: 9/30/08


No hypogastric pain/uterine contractions


O> BP 100/70 PR 80 RR 17 T 36.5

FHT 144 bpm

P> Continue Isoxilan tablet q 8 hrs

Measure fundic height and weight weekly

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OBhiriskcon Caraan Updated