Questions to answer on this write up
1)Explain how sociocultural factors might impact the care plan for patients in the case study your colleagues selected.
2) Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or contrasting perspectives
Casestudy 2
You are seeing a 28-year-old African American female, G6 P 3115, who is currently on oral combined hormonal contraception. She’s here because she and her partner would like to have another child. She heard “it takes a while to become pregnant after being on the Pill,” so she discontinued them three months ago. They haven’t been using any contraception since then. Upon questioning, she states that on the Pill, sometimes her menstrual periods are very light and once she didn’t have one at all. Her urine pregnancy test in the clinic is positive. Her LMP was 7-14-12. You are seeing her on 12-3-12.
Data about a woman’s last normal menses are needed to make a determination of gestational age and an estimated date of birth, if the woman is not certain of the date of her LMP, an ultrasound is needed to date the pregnancy (Schuiling & Likis, 2017). The estimated delivery date (EDD) can be calculated using Nagele’s rule, gestational wheel, or an application. The patient in the above case study states her LMP was on 7/14/12 & reports discontinuing her COC three months prior to today’s appointment. Based on her LMP and positive urine pregnancy test her EDD is 4/20/13 making her 21 weeks and 4 days pregnant.
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According to CDC (2019), the recommended clinical timeline for the first prenatal visit, which would be this visit, includes screening for Syphilis, HIV, HBV, HCV, Chlamydia, and Gonorrhea. A complete physical assessment should be completed along with a pap smear if that hasn’t been done. Since the patient is already in the second-trimester first trimester screenings (blood tests, maternal screenings, and fetal screenings) should be discussed and offered regardless of the risk of the condition.
For this patient who is a G6P3115, a discussion should be done regarding her previous pregnancies, delivery and if there were any complications so interventions can be anticipated to prevent or minimize morbidity. The “quad” or “quadruple” blood test measures the levels of four different substances in your blood screening for Down syndrome, Trisomy 18 and neural tube defects is usually done between 15 weeks and 22 weeks (American College of Obstetricians and Gynecologists, 2019). An anatomy scan is also completed 18 weeks and 22 weeks of pregnancy checks for major physical defects in the brain, spine, facial features, abdomen, heart, and limbs. Ensuring that the patient is taking prenatal vitamins containing Folic acid 800mg, DHA and iron supplementation is important for the healthy maturation of the baby. The patient should also be informed of the frequency of visits which in her case would still be once every 4 weeks through 28 weeks, every 2 weeks 28-36 weeks and weekly from 36 weeks till birth unless any prior pregnancy complications or preterm deliveries have been disclosed (OWH, 2019). Educating the patient on a nutritious, well-balanced diet and exercising in moderation regularly with regular prenatal care/visits is essential to the good health of her baby.
References
American College of Obstetricians and Gynecologists. (2019). Prenatal Genetic Screening Tests. Retrieved from https://www.acog.org/-/media/For-Patients/faq165.pdf
Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.
The Centers for Disease Control and Prevention. (2019). Recommended Clinician Timeline for Screening Syphilis, HIV, HBV, HCV, Chlamydia, and Gonorrhea. Retrieved from https://www.cdc.gov/nchhstp/pregnancy/screening/clinician-timeline.html
Office on Women’s Health. (2019). Prenatal care and tests. Retrieved from https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests
