Case 053: Pregnancy

PATIENT PRESENTATION

Chief Complaint

“I’m expecting my first child, and I’m excited!”

History of Present Illness

Beverly King is a 32-year-old Caucasian female who presents for a routine prenatal appointment with her first pregnancy.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What resources are available that provide data on medication use in pregnancy?

   Hint: See Table 48-4 in PPP

2. What plan should you propose to address the urinalysis results?

   Hint: See Table 48-7 and Conditions Prevalent in Pregnancy and Lactation in PPP

3. How often should her TSH concentration be monitored and why?

   Hint: See Conditions Prevalent in Pregnancy and Lactation in PPP

4. What options can be used for induction of labor?

   Hint: See Table 48-7 and Conditions Prevalent in Pregnancy and Lactation in PPP

5. What treatment can be recommended for bacterial vaginosis?

   Hint: See Table 48-7 and Conditions Prevalent in Pregnancy and Lactation in PPP

FOLLOW-UP

The patient returns for follow-up from delivery 6 weeks later. She is taking her multivitamin and levothyroxine. She is experiencing a yeast infection. What do you suggest for treatment of vulvovaginal candidiasis since she is breastfeeding?

Hint: See Table 48-7, Conditions Prevalent in Pregnancy and Lactation, and chapter 85 in PPP

CASE SUMMARY

Global Perspective

Medication use in pregnancy should only be recommended when the benefit outweighs potential and perceived risk of treatment or lack thereof. Untreated medical conditions such as hypothyroidism can lead to significant fetal and maternal morbidity and mortality. In addition, asymptomatic bacteriuria and urinary tract infections can lead to pregnancy complications. These conditions must be addressed and treated appropriately.