Question

A 35-year-old woman presented to the prenatal clinic after missing her last two menstrual cycles. Her home pregnancy test was positive and an ultrasound confirmed the pregnancy. Gestational age was calculated to be at 10 weeks. An initial assessment of the woman’s medical and obstetric history included the following: She smoked tobacco for 15 years and currently smokes one pack per day; she had recently used cocaine but stated it is not frequent; she denied alcohol use. Her obstetric/gynecologic history included an uncomplicated spontaneous vaginal delivery at 35 weeks’ gestation 4 years ago and 2 years later a cesarean section at 36 weeks’ gestation for nonre- assuring fetal heart tones. Her medical history included chronic hypertension and a history of asthma, for which she had never been intubated or hospitalized. Her vital signs were as follows: temperature 36.7°C, respiratory rate of 20 breaths per minute, heart rate of 86 beats per minute, BP 142/79 mm Hg. Lab results: hemoglobin 13.0 g/dL, hematocrit 37%, white blood cell count 8000, blood type A–, Rh antibody screen positive. She was negative for gonorrhea, chlamydia, and HIV.

1. At this time, what recommendations would you give this patient to improve her health?

Answer 1

Ans patient is puts under high risk for pregnancy complications

- multiple gestation leads to anemia.

- hypertensive leads to preeclampsia.

- asthma leads to preterm labour

- smoking leads to preterm labour

- cocaine in pregnancy can increase the risk of miscarriage, IUGR and low birth weight.

Recommendations give this patient to improve her health

1. Smoking cessation should be recommended at every visit. Necotine replacement product is can be offered.

2. Mother should be discontinue to cocaine while pregnancy. These may cause low birth weight and expose infant may have difficulty in arising and feeding and leads to fetal death

3. Should take iron rich and protein rich diet

4. Untreated hypertension will cause blood flow resistance, IUGR, preeclampsia. Antihypertensive drugs may beneficial for mother but harmful for fetla development. It should recommended to avoid smoking and sodium rich diet.

5.Keep asthma pump with her and prevention of aggravated situation or allergic agent to prevent the asthma attack

6. Fetal movement and it's count recommend

7. Exercise like moderate intensity aerobic exercise

8. Inform about the Rh immune globulin shot at 28 weeks

9. Health education related to ailments of pregnancy

10. Advice for contraceptive methods for next pregnancy and after 35 years she will be under high risk for next pregnancy with multiple gestation.

FOR ANY DOUBT POST A QUESTIONS IT WILL BE HIGHLY APPRECIATED ?