Tara is a 28yo, G4 P2012, who was seen for an ultrasound evaluation and to set-up PNC. She has had limited PNC and has not had an ultrasound and is uncertain of her LMP. She believes that it was in June and she was having regular cycles but again is not certain. She overall denies any problems with the pregnancy to date. She does have a longstanding history of opiate abuse and has been using 2-4 mg of Suboxone off the street recently. She does have some issues with depression and anxiety but is currently not on treatment. She does smoke cigarettes at about ½ pack per day. She was further counseled on cessation. She has been taking 4 flinstone vitamins daily and was told to drop this to 2, primarily to make sure that she does not have any issues with excess vitamin A.
On today’s evaluation the fetal measurements are symmetrical and average out to 18 weeks 6 days giving her an EDD of 04/03/18. The amniotic fluid volume is normal, and the cervix is long and closed with no evidence of membrane funneling. A complete fetal anatomical survey was performed, and no major/minor malformations were noted at this time within the resolution of the …show more content…
The plan will be to start at 4 mg daily and get her stabilized and then we can follow through on a process of withdrawal and going to naltrexone. She was told that if she changed her mind about this plan that she could let us know at any time. We also discussed the flu vaccine and the whooping cough vaccine. She is interested in Pertussis but at this point in time wants to think further about the flu vaccine (despite being told of its safety and concerns for her not obtaining it). Her prenatal lab work was done today along with a quad screen. In the meantime, the plan will be for her to follow-up in 3 weeks for interval growth and to complete the fetal anatomy assessment and to follow-up on the lab work obtained
On today’s evaluation the fetal measurements are symmetrical and average out to 18 weeks 6 days giving her an EDD of 04/03/18. The amniotic fluid volume is normal, and the cervix is long and closed with no evidence of membrane funneling. A complete fetal anatomical survey was performed, and no major/minor malformations were noted at this time within the resolution of the …show more content…
The plan will be to start at 4 mg daily and get her stabilized and then we can follow through on a process of withdrawal and going to naltrexone. She was told that if she changed her mind about this plan that she could let us know at any time. We also discussed the flu vaccine and the whooping cough vaccine. She is interested in Pertussis but at this point in time wants to think further about the flu vaccine (despite being told of its safety and concerns for her not obtaining it). Her prenatal lab work was done today along with a quad screen. In the meantime, the plan will be for her to follow-up in 3 weeks for interval growth and to complete the fetal anatomy assessment and to follow-up on the lab work obtained