Sarah is a 24yo, G3 P0020, who is currently 10 weeks 5 days. She has a notable history for 2 prior first trimester losses; one required a D & C. She is obese with a BMI of 39. Because of these losses, she has been followed very closely with this pregnancy. She also had fairly significant bleeding between 6-8 weeks and a subchorionic hemorrhage was noted, but on her last scan at 8 weeks it was no longer seen. She has had a small cyst on the left ovary. She is here today for viability.
On ultrasound, there is a live fetus whose crown-rump length is consistent with menstrual dates. There was no evidence of a subchorionic hemorrhage. We do continue to see a simple cyst on the left ovary measuring 1.6 x 1.9 cm.
I again had a long discussion with Sarah today. While I do not consider us to be completely out of the woods until 12+ weeks, I counseled her on the option of FTS and she does desire this. I scheduled her to return in 2 weeks for FTS and Prenate I if she has not had this completed by that visit. She
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She had her tonsils removed at the age of 19 and had a fairly significant postoperative hemorrhage 5 days out. She also reports heavy menstrual cycles. On further inquiry with her prior losses she had one D & C and reports that she had bleeding for 3 days after and at least one week with her spontaneous loss. She has never required a blood transfusion. I informed her that testing for bleeding disorders such as von Willebrand, which is the most common, is difficult in pregnancy because all of these factors are upregulated. It would better to test outside of pregnancy but certainly in this pregnancy we will be conscience of this possibility. Because she has not required blood transfusions previously, I am overall reassured. She is scheduled to return here in 2 weeks for nuchal translucency and then will have ongoing PNC through the Housestaff Resident Obstetrical