Reference no: EM133234546
Patient admitted for 34-week intrauterine pregnancy. The 34-year-old para 0-2-4-1 agrees with the 15-week sonogram giving her a 34-week intrauterine pregnancy with estimated date of confinement to five weeks from now. She was recently hospitalized for elevated blood pressure and proteinuria. She received two doses of betamethasone. The patient left against medical advice.
She is admitted today for an increase in blood pressure to 180s over 100s and a headache. The unborn fetus had previously been transverse and today on ultrasound is vertex. Patient is crying and appears to be very upset about early delivery. She denies rupture of membranes or vaginal bleeding. Her prenatal labs include blood type B+, antibody negative, Pap within normal limits, positive PPD, rubella immune, hepatitis B surface antigen negative, VDRL nonreactive, HIV negative. Cystic fibrosis screen negative. Toxo IgG and IgM negative. Patient has an obstetric history of spontaneous vaginal delivery with preterm labor times two at 35 and 36 weeks. Elective abortion times two. Spontaneous abortion times two. She has a history of preeclampsia in both of her vaginal deliveries.
The patient was admitted to labor and delivery unit, and she was thoroughly informed about having early delivery. She was started on magnesium sulfate as seizure prophylaxis. Intravenous antibiotics were also started. It was decided that since she had severe preeclampsia, cesarean section was warranted. In addition, the patient also requested a bilateral tubal interruption. She stated that she understands the permanence of the procedure and the fact that there is a failure rate and an increased risk of ectopic pregnancy. A low cesarean section as performed, which resulted in a single healthy male child weighing 6 pounds. Postoperatively, the patient was transferred to the mother/baby unit where she has remained without complaints. Her pain has been well controlled initially by IV medication and then by oral medication. Currently, she is ambulating and voiding without difficulty. She is tolerating a regular diet, and her lochia has been less than menses. On postoperative day three, patient was discharged home.
Final diagnosis: 34-week intrauterine pregnancy with severe preeclampsia.
Procedures: Low transverse cesarean delivery. Pomeroy bilateral tubal ligation.