G2P1001 Week 5 Assignment
Wesley Chen
H&P Assignment
ID: Patient is 23 yo G2P1001 At 32wk3d GA determined by U/S admitted for vaginal bleeding.
HPI: The patient first noticed vaginal bleeding this morning when she woke up at 6:30 am to use the restroom. She noticed bleeding in her clothing and blood clots in the toilet bowl. She reports bleeding 1 cup (~250ml) total this morning. In addition, she has a positive h/o placenta previa with her current pregnancy determined by U/S. She denies any similar episodes in the past with either pregnancy, as well as having pain, cramps, nausea, fever, chills or recent trauma.
PNL:
- Blood type: O+
- Rubella Ab titer: Immune - VDRL: NR
- Hep B: NR - Cervical gonorrhea & Chlamydia culture: unknown - Pap smear: normal - PPD: …show more content…
Risk factors for placenta accreta are prior c-section and any other uterine surgeries. A presentation of placenta previa plus previous h/o other uterine surgery carries a 4% incidence of placenta accreta. In addition, a history of c-section plus a presentation of placenta previa in current pregnancy is associated with a 10-35% incidence of placenta accreta.(Uptodate) Management of placenta accreta depends on whether uterine preservation is an option or strongly desired. Two thirds of patient with a placenta accreta will require cesarean hysterectomy. Other interventions to achieve hemostasis that are packing lower segment with subsequent vaginal removal of packs in 24 hours and interrupted circular suture of lower uterine segmentation on serosal surface of uterus. If complete placenta accreta is suspected, management includes having at least 4 units of matched blood on hand, an anesthesiologist present in room, and surgical instruments sterile and ready for delivery. Hysterectomy is associated with the highest survival and lowest morbidity rate of the treatments available for placenta accreta. There are three other options that can preserve the uterus. The first option is oversewing defects after placental removal in conjunction with oxytocin and antibiotics. The second option involves localized resection of uterus and repair. The third option entails curettage of the uterine cavity. Alternative management without intervention is to leave the placenta in situ and remove at a later date, around two
H&P Assignment
ID: Patient is 23 yo G2P1001 At 32wk3d GA determined by U/S admitted for vaginal bleeding.
HPI: The patient first noticed vaginal bleeding this morning when she woke up at 6:30 am to use the restroom. She noticed bleeding in her clothing and blood clots in the toilet bowl. She reports bleeding 1 cup (~250ml) total this morning. In addition, she has a positive h/o placenta previa with her current pregnancy determined by U/S. She denies any similar episodes in the past with either pregnancy, as well as having pain, cramps, nausea, fever, chills or recent trauma.
PNL:
- Blood type: O+
- Rubella Ab titer: Immune - VDRL: NR
- Hep B: NR - Cervical gonorrhea & Chlamydia culture: unknown - Pap smear: normal - PPD: …show more content…
Risk factors for placenta accreta are prior c-section and any other uterine surgeries. A presentation of placenta previa plus previous h/o other uterine surgery carries a 4% incidence of placenta accreta. In addition, a history of c-section plus a presentation of placenta previa in current pregnancy is associated with a 10-35% incidence of placenta accreta.(Uptodate) Management of placenta accreta depends on whether uterine preservation is an option or strongly desired. Two thirds of patient with a placenta accreta will require cesarean hysterectomy. Other interventions to achieve hemostasis that are packing lower segment with subsequent vaginal removal of packs in 24 hours and interrupted circular suture of lower uterine segmentation on serosal surface of uterus. If complete placenta accreta is suspected, management includes having at least 4 units of matched blood on hand, an anesthesiologist present in room, and surgical instruments sterile and ready for delivery. Hysterectomy is associated with the highest survival and lowest morbidity rate of the treatments available for placenta accreta. There are three other options that can preserve the uterus. The first option is oversewing defects after placental removal in conjunction with oxytocin and antibiotics. The second option involves localized resection of uterus and repair. The third option entails curettage of the uterine cavity. Alternative management without intervention is to leave the placenta in situ and remove at a later date, around two