History of present illness(ll) Four days laterlat 33 weeks 2 days of gestation) Persistent itching, nausea, and occasional vomiting, along with a new pruritic rash on her abdomen Fetal well-being were reassuring The patient returned home
History of present illness(II) • Four days later(at 33 weeks 2 days of gesta(on) – Persistent itching, nausea, and occasional vomi(ng, along with a new pruri(c rash on her abdomen – Fetal well-being were reassuring • The pa(ent returned home
History of present illness(lll) This evaluation On arrival Nausea, decreased appetite, frequent urination (which was unchanged from baseline), subjective fevers, and chills Contractions that had occurred during the previous 2 days and had resolved spontaneously No bleeding, dysuria, or loss of fluid
History of present illness(III) This evalua(on • On arrival – Nausea, decreased appe(te, frequent urina(on (which was unchanged from baseline), subjec(ve fevers, and chills – Contrac(ons that had occurred during the previous 2 days and had resolved spontaneously – No bleeding, dysuria, or loss of fluid
History of present illness(lll) This evaluation Physical examination Temperature was381℃ Blood pressure 120/71 mm Hg Pulse 66 beats/min Respiratory rate 22 breaths/ min Abdomen was soft and nontender Two fetal heart rates were 140 and 150 beats/ min, with accelerations and moderate variability no decelerations were noted
History of present illness(III) This evalua(on • Physical examinaBon – Temperature was 38.1℃ – Blood pressure 120/71 mm Hg – Pulse 66 beats/min – Respiratory rate 22 breaths/min – Abdomen was soJ and nontender – Two fetal heart rates were 140 and 150 beats/ min, with accelera(ons and moderate variability; no decelera(ons were noted
History of present illness(lll) This evaluation Laboratory data(o) Table 1. Laboratory Data. 1 Day arter Reference Range, 16 Days before On This This Evaluation, Variable Adults This Evaluation Evaluation on Admission Hematocrit(%) 36.046.0 31.2 30.1 (women) Hemoglobin(g/di) 12.016.0 10.1 10.1 (women) White-cell count (per mm) 4500-11,000 4940 5940 Differential count(%) Neutrophils 40 76.9 72.5 Lymphocytes 22-44 16.6 190 Monocytes 4-11 4.9 Eosinophils 0.2 Basophils 0-3 1.0 0.7 Platelet count(per mm) 150,000-400,000 209,000 205,000 Protein(g/dl) Total 6.08.3 6.6 6.4 Albumin 3.3-5.0 Globulin 1.9-4.1 3.1 3.2
History of present illness(III) This evalua(on Laboratory Data(I)
History of present illness(lll) This evaluation Treatment protocols a urine culture was obtained Acetaminophen was administered, and the infusion of intravenous f luids and fetal monitoring were continued The fetal heart patterns remained reassuring and the patient reported increased fetal movement She was discharged home later that evening and advised to monitor her temperature, to return in 2 days for an evaluation Induction of labor was scheduled for 5 days after this evaluation
History of present illness(III) This evalua(on • Treatment protocols – A urine culture was obtained – Acetaminophen was administered, and the infusion of intravenous f luids and fetal monitoring were con(nued – The fetal heart pa_erns remained reassuring, and the pa(ent reported increased fetal movement – She was discharged home later that evening and advised to monitor her temperature, to return in 2 days for an evalua(on – Induc(on of labor was scheduled for 5 days aJer this evalua(on