July 28, 2022

Dr. Cilliers Mirais

RE: Kristen Black

DOB: June 26, 1992

Dear Cilliers,

Thank you for asking me to see Kristen. Kristen is a 30 year old G3T1P0A1L1 that is currently 31 weeks
one day pregnant. She had a previous cesarean section done by me and you have asked me to discuss
the delivery with her.

In her previous obstetrical history she had one early spontaneous abortion. In 2019 she had
uncomplicated pregnancy. She went into active labor. She had a prolonged second stage. The fetal head
was in occipitoposterior position as well as there was present. A cesarean section was done after she
was pushing down for several hours and a male fetus of 3.5 kg was born.

In this pregnancy a due date is set at September 28, 2022 and this is because of an ultrasound that was
done on February 21, 2022 when she was nine weeks pregnant. In this pregnancy she is blood group O
positive. Ultrasound confirms a placenta to be posterior but low and about 3.5mm from the internal os
of the cervix. She is booked for a follow-up ultrasound. She has not had any bleeding. Her gestational
diabetes testing is negative although she could not complete the conformation diabetes test because of
vomiting.

In her family history there is nothing of note. She herself has not had any chronic medical condition
except for anxiety for which she takes Cypralix. The only surgery she had was a cholecystectomy the
cesarean faction could not a lazy for medication. She does not smoke and has no history of alcohol or
substance abuse.

On assessment blood pressure was 92/56 on abdominal examination there is a singleton pregnancy in
vertex position and the symphysis pubis measurement is 31cm. the fetal heart rate was normal.

Kristen and I proceeded to discuss the delivery. She was counseled with VBAC is recommended as a
safer option. With her VBAC there is a risk of uterine rupture which does have a very high complication
for her and her fetus but the risk is only about 0.5%.

We also discuss the procedure of elective cesarean faction. Possible risks and complications were
discussed especially the risks of infection, bleeding, blood transfusion, injuring surrounding structure
when doing the surgery as well as having to return OR to control operative bleeding. The increased
morbidity for fetus especially respiratory morbidity was also discussed.

The patient at the pregnant time wants to proceed with VBAC. I did give an appointment to see me
about ten days before due date to reassess.

Thank you for your kind referral.

Dr. Lampen.