Health And Social Care Reflection Paper

Jessie is a 37yo, G3 P1011, who is presently 23 weeks 3 days. She is well known to our office after she was admitted at 20 weeks for vaginal bleeding and possible PPROM. It does appear that she perhaps resealed as at her on week post hospital follow-up she did have amniotic fluid that appeared somewhat low-normal. We have seen her weekly since then and she has had low-normal fluid continuously. Her transvaginal cervical length has always been long and reassuring. She does have a known low-lying placenta. The concern for PPROM came from her evaluation in Parkwest triage with her initial presentation of bleeding as they felt it was a bit more watery then what it typically could be. We have also been trying to complete her anatomy by way …show more content…
We finalized things from our office. We discussed that if this was PPROM I do think that she could have resealed. The other possibility is that this is placental insufficiency; however, with reassuring growth today I do feel this is less likely. Finally, the 3rd possibility would be that she will continue to have low-normal fluid that will continue to be normal for this pregnancy. I would recommend moving forward with growth scans every 3-4 weeks to assure there is normal growth assuring normal placental function. I would also recommend weekly AFI’s at least until 26-28 weeks. You may consider betamethasone if she stays low-normal after 24 weeks. If there is either an AFI < 5 cm or no 2 cm deepest pocket, I would consider a referral back to our office. She will be out of work until 26-28 weeks. Finally, as you scan in the future I would recommend that you continue to look at the heart to clear the LVOT and assure that there is no evidence of a VSD. I did give her the limitations of ultrasound while I do not see any large VSD’s there certainly could be a small one that is difficult to evaluate. For now, she is not scheduled to follow-up here but should have weekly evaluations through your office moving