Question

High-Risk Obstetrics Consultation Report

Define terms related to menstruation, pregnancy, and postpartum

Describe normal and abnormal findings in the neonate

Describe disorders and diseases of the female reproductive system

Describe tests and procedures related to the female

Handout Instructions: Below is an item from a patient’s medial record. Read it carefully, make sure you understand all the medical terms used, and then answer the questions that follow.

High-Risk Obstetrics Consultation Report

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.

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

Describe this patient’s menstrual history.

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

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

Answer 1

1. Menstruation

Menstruation: The periodic blood that flows as a discharge from the uterus. Also rendered to as menorrhea, the time for the duration of which menstruation occurs is referred to as menses. The menses occurs at approximately 4 week intervals to compose the menstrual cycle.

Pregnancy

The period between 37 weeks and 38 weeks, six days of gestation is viewed"early term." Thirty-nine weeks to 40 weeks, six days is regarded "full term"; between fortune weeks 0 days and fortyone weeks, six days is "late term"; and 42 weeks and past is regarded "postterm."

Postpartum depression can also be improper for baby blues at first — but the symptoms and signs are extra intense and final longer, and might also in the end intervene with your capacity to care for your child and deal with different day by day tasks. Symptoms typically increase within the first few weeks after giving birth, however can also begin earlier at some stages in pregnancy― or later — up to a 12 month after birth.

2. Normal and abnormal findings of Neonates

Normal findings of neonates

. crying

Normal crying- all neonates cry when they are born.

. Feeding

Breast feeding- frequent feeding prevents the newborn from developing hypoglycemia

. Weight changes

Weight loss stops at 5 days of life

. Genitourinary and stooling

Stool- first meconium typically passes

Urine- first urine usually occurs in the 24 hrs of life.

Abnormal finding of neonates

The abnormal findings of newborn assessment should include an examination for size, macrocephaly or microcephaly, changes in skin color, signs and symptoms of beginning trauma, malformations evidence of respiratory distress, stage of arousal, posture, tone, presence of spontaneous movements, and symmetry of movements.

3. Disorders and diseases in the Female reproductive system

Endometriosis – A situation involving colonization of the abdominal/pelvic cavity with islands of endometrial tissue. Endometrium is the lining layer of the uterus which sloughs off with every menstruation. If endometrial tissue flushes up the uterine tube and spills into the abdomen (peritoneal cavity), the clots of endometrial tissue can attach  to abdominal organs such as the bladder, rectum, intestinal loops and then cycle alongside with the uterus in response to monthly changes  in ovarian hormones. Bleeding into the irritates the lining membrane, the peritoneum, and causes abdominal pain.

Pelvic inflammatory disease (PID) – Although men have a closed abdominal cavity, the female abdominal cavity has a direct anatomical course from the outside world by way of the female reproductive tract. Bacteria can make their way up the vagina, through the uterus, and traverse the uterine tubes which open into the abdominal cavity. Inflammation of the lining of the abdominal cavity, the peritoneum, reasons abdominal pain. Although there are many conceivable motives of PID, gonorrheal contamination is one of them. Chronic Inflammation of the uterine tubes can occlude them resulting in infertility.

Prolapsed uterus– The uterus is nearly without delay above the vagina. In fact, the cervix, the neck region, of the uterus extends into the higher vagina. Ligaments hold the uterus in suitable function so that it does no longer prolapse or herniate into the vagina. Severe prolapse can result in the uterine cervix protruding from the vaginal opening. Surgical repair is commonly required to repair the uterus to its ideal anatomical position.

4. Test and procedures related to the female

Ovulation testing. A blood check measures hormone tiers to determine whether or not you're ovulating.

Hysterosalpingography. Hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee) evaluates the circumstance of your uterus and fallopian tubes and looks for blockages or different problems. X-ray distinction is injected into your uterus, and an X-ray is taken to determine if the cavity is regular and to see if the fluid spills out of your fallopian tubes.

Ovarian reserve testing. This testing helps decide the quantity of the eggs on hand for ovulation. This method regularly starts offevolved with hormone checking out early in the menstrual cycle.

Other hormone testing. Other hormone tests take a look at levels of ovulatory hormones, as properly as pituitary hormones that control reproductive processes.

Imaging tests. Pelvic ultrasound looks for uterine or ovarian disease. Sometimes a sonohysterogram, also called a saline infusion sonogram, is used to see small print inner the uterus that are no longer viewed on a normal ultrasound.