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A 37 year old pregnant female presents to Labor and Delivery because of significant vaginal bleeding over the past hour. The patient also reports some contractions, but denies any continuous abdominal pain. She denies any recent trauma.
Past Obstetrical History:
-G3 T2 P0 A0 L2
-2 previous SVD’s (spontaneous vaginal delivery)
-Last birth was a female 9 years ago, weighed 3800 grams
-First birth was a male 16 years ago, weighed 3350 grams
-No previous obstetrical complications or morbidity
Past Medical History:Â None
Past Surgical History:Â None
Family History:Â Unremarkable, no history of twins or multiple gestations
Social History: Patient lives with her husband and 9 year old daughter and 16 year old son. Denies any smoking, alcohol or other drug use during her pregnancy. Denies any spousal abuse. Completed elementary school, currently works as a housewife. Low economic status.
Current Gestational History:
-G3 P2002
-First Day of Last Menstrual Period:Â 4/11/16
-Estimated Date of Delivery:Â 1/18/17
-Estimated Gestational Age (based on dates):Â 32 4/7 weeks
-No prior antenatal care
Physical Assessment:
Vital Signs:Â BP – 100/60, P – 110
General Appearance:Â Anxious, pale
Skin: Elastic, capillary reflex < 2 seconds Fundal Height: 30 cm Fetal Lie: Longitudinal Contractions: frequency- 2 to 5 minutes, duration 30 to 40 seconds Fetal Heart Rate: 180 x minute Transabdominal Ultrasound Number of fetuses: 1 Lie:  Longitudinal Presentation: Cephalic Position: Right Occiput Anterior Fetal Heart Rate: 172 x minute Fetal Movements: Present Placenta:  Total occlusion of internal cervical os  Labs WBC-22,000 cells/mcL Hgb- 9.4 grams/dL Hct- 29 %   Should you perform a vaginal exam to see how many centimeters she is dilated?  Why or why not?   Identify and describe three potential causes of her vaginal bleeding? Which is the most likely?     Are her labs normal? What are normal ranges for her labs? What are probable causes of her lab values? What are the three most common types of Placenta Previa? Describe each type and the common symptoms Which type of placenta previa does this client have? Which client symptoms and diagnostic test results support your answer? SCIENCE HEALTH SCIENCE NURSING HCA MISC
