Patient is seen by obstetrician today for moderate vaginal bleeding without any cramping or pelvic pain. Patient is 23 years old. She is currently estimated to be at 175 days of gestation. Amniocentesis at 20 weeks indicated male fetus with no evidence of genetic or developmental disorders. This patient is multigravida but nullipara with three early spontaneous abortions without obvious causes. She was diagnosed with cancer of the left ovary 4 years ago. It was treated with a left oophorectomy and chemotherapy. She continues to undergo full-body CT scan every six months, and there has been no evidence of cancer since that time. Pelvic ultrasound indicates placenta previa with placenta almost completely overlying cervix. However, there is no evidence of abruptio placentae at this time. Fetal size estimate is consistent with 25 weeks of gestation. Fetal monitoring revealed that the FHR is strong with a rate of 130 beats/minute. The placenta appears to be well attached on ultrasound, but the bleeding is cause for concern. With the extremely low position of the placenta, this patient is at very high risk for developing abruptio placentae. She may require early delivery by cesarean section if bleeding increases. She will definitely require C-section at onset of labor.
1. Describe in your own words the treatment this patient received for her ovarian cancer. What procedure does she continue to have every six months?
2. This patient had an amniocentesis at 20 weeks of gestation. Describe this procedure and why it is performed.
3. What occurred during this patient’s first three pregnancies? Describe what terminated the pregnancies.
4. Describe what fetal monitoring is. What is FHR?
5. This patient has placenta previa. What procedure discovered this condition? The physician, however, is much more concerned about abruptio placentae. Explain why.
6. How will this infant need to be delivered? Describe this procedure.