Good evening doc, respectfully referring 1 patient for comanagement po

Dr. Cole/Buño/ Cagampan

Good evening, Ma'am. This is Pat Cagampan 2nd year OB Resident. Respectfully referring 1
patient to your service for admission:

TULIPAS, ERICA
21 years old
Gravida 1 Para 0 Pregnancy Uterine 29 weeks AOG by 1st trimester ultrasound
Cephalic not in labor
Chronic hypertension with severe features
t/c Symmetric IUGR
Oligohydramnios
Gravidocardiac (Rheumatic Heart Disease) NHYA FC I, WHO I
Hypothyroidism

Patient is a nonregistered, referred case who came in due to an ultrasound finding of

oligohydramnios on scan.

Cognizant of pregnancy due to missed menses prompting a pregnancy test showing a postive
result. She had 3 PNCU at a Private OB where she had prenatal workups done and was
prescribed prenatal medications.

8 hours prior to consult, had her prenatal consult where she noted good fetal movement, no
headache, blurring of vision, no watery or bloody discharge. She had an ultrasound which
showed oligohydramnios. BP was also taken; 200/100 and was given unrecalled
antihypertensives. She was then advised transfer to our institution for further evaluation and
management

Currently, at the ER, she had BP elevation of 200/100, with FHT at 150bpms, we gave her
hydralazine 5mg/SIVP and started her on MgSO4 drip.

Patient is a nonsmoker and a nonalcoholic beverage drinker.

She is a known hypertensive since 2020 where she is maintained on Losartan 50mg/tab 1 tab
OD and Aspirin 80mg/tab 1 tab OD. She is also diagnosed with RHD since 14 years old,
maintained on Penicillin G injection 1m units given every 22 days. Last dose received was May
10, 2023.

Current BP:
180/100
102
17cpm
36.7C
98%

FH: 18cm
FHT: 140s
EFW: 1000g by Palm, 930g by Johnsons rule
IE: cervix is soft, closed with no bleeding

STD workup are non-reactive

75gOGTT showed normal results

Latest Ultrasound: May 15, 2023 OB Sono

Single live intrauterine pregnancy of 24 weeks and 5 days age of gestation
Placenta Left anterolateral grade II high lying
Amniotic fluid volume 1.58cm SVP
EFW below 3rd percentile 713g
BPS 6/8

Awaiting CBC, Urinalysis, Na, K, Crea

Plan:
Admit for dexamethasone completion and BP control
NPO for now

A. Chronic Hypertension w/ severe features:

For ALT, LDH, 24 hour urine protein
IVF: Give MgSO4 4g loading dose then start MgSO4 drip 10mg + 1L PNSS to run at 1g/hr via
soluset
Increase Methyldopa 250mg/tab 2 tabs Q8
Hydralazine 5mg/SIVP for BP more than or equal to 160/110mmHg
Refer to Ophtha for baseline fundoscopy
Refer to Perinatology for co-management
Watch out for signs of MgSO4 toxicity

B. t/c Symmetric IUGR

For BPS with Fetal biometry and doppler velocimetry tomorrow AM
Start Onima tab 1 tab TID

C. Oligohydramnios
Incrase oral fluid intake

D. Hypothyroidism
Refer to IM Endo for comanagement
E. Gravidocardiac
for 12L ECG
Retrieve 2D Echo result
Refer to IM Cardio once at the ward

F. For the pregnancy/prematurity

Dexamethasone 6mg/IM Q12 for 4 doese (1 dose given at the ER)
FeSo4 tab 1 tab BID
Calcium + Vit D3 tab 1 tab BID
Multivitamins tab 1 tab OD
Hook to continuous CTG
Watch out for sudden abdominal pain, headache, blurring of vision and seizure episodes

Thank you very much, docc