Age: 32.0
Sex: F
Vaccine: COVID19
Symptoms: Hyperglycaemia, Hypertension, Incision site haemorrhage, Induration, Insulin therapy
Clinical narrative: Patient is a 32 y.o. G5P0040 female at 31w0d with Estimated Date of Delivery: 8/17/22 who presents today with preterm contractions and decreased fetal movement. She was diagnosed with COVID-19 on 6/9 and since then had been having cramping/contractions which increased in severity and frequency on 6/15 which promped her to come into triage. She reports the contractions were every 10 minutes or so. She denies LOF and vaginal bleeding. She now reports improved fetal movement but is concerned due to her history of prior losses. She reports her COVID-19 symptoms are improving but she continues to feel fatigued and is having a headache. She denies vision changes and a RUQ pain.    The patient is a 32 y.o. G5P0040 at 31w1d who was admitted to labor and delivery for observation due to preterm contractions, decreased fetal movement and variable decelerations noted on NST in traige. Her pregnancy is complicated by COVID-19 in pregnancy, chronic hypertension, history of recurrent miscarriage (for which she is on Lovenox 40 mg BID, Prograf 4 mg and Synthroid). She was also on Prednisone earlier in pregnancy and is on insulin for steroid induced hyperglycemia. On admission, she received betamethasone and was started on IV magnesium for neuroprotection. She was noted to have persistent fetal bradycardia (105-107) that did not improve with fetal resuscitation methods. Her c-EFM was reviewed with the MFM team and the decision was made to proceed with a cesarean section due to category II fetal heart tones remote from delivery. Due to her recent Lovenox dose, she required general anesthesia. Patient is a 32 y.o. G5P0141 who is POD#1 from a pLTCS for Category II FHT remote from delivery who developed significant bleeding from her c-section incision refractory to pressure and was taken to the OR for exploration of her wound.   REMARKABLE FINDINGS: - Pfannenstiel incision, oozing, with ecchymosis and with approximately 8x5 cm area of induration - Subcutaneous tissue with infiltrating clot, tracking toward the right flank - area of active bleeding from the inferior skin a   SURGICAL COMPLICATIONS: None    TECHNIQUE: The patient was taken to the operating room, where general anesthesia was obtained without difficulty.  She was placed in a dorsal, supine position and prepped and draped in the usual manner.  The existing Pfannenstiel incision was opened using his scalpel.  3-0 Vicryl was removed from the subcutaneous tissue using pickups and suture scissors.  An area of active bleeding was noted along the anterior portion of the skin incision 3 inches in  from the right corner, which was cauterized with the Bovie.  The wound was explored and the fascia was noted to be intact.  Approximately 20 mL of clot and loose blood was removed from the wound.  Bovie cautery was used to obtain hemostasis.  An area of persistent bleeding was noted deep in the subcutaneous tissue just inferior to the right corner of the skin incision.  3-0 Vicryl was used in figure-of-eight fashion and hemostasis was obtained.  The wound was irrigated and suctioned.  No active bleeding was noted.     The subcutaneous tissue was irrigated and excess fluid removed with suction.  The subcutaneous tissue was reapproximated using 3-0 Vicryl in a runnig fashion. The transverse skin incision was repaired with 3-0 Stattafix. Swift-set skin glue was applied.  A pressure dressing   The patient tolerated the procedure well.  EBL 20 mL. Sponge, lap and needle counts correct x2.  No antibiotics were indicated.  The patient was transferred to the recovery room in good condition. Dr was present and scrubbed for the entire procedure.  Intake    Transfuse RBC 300.00 mL   Plasma-Lyte-A infusion 700.00 mL   sodium chloride 0.9% (NS) infusion 900.00 mL   Total Intake 1900 mL       Output   Est. Blood Loss 20 mL   Anesthesia Foley Output 600 mL   Total Output 620 mL       Net   Net Volume 1280 mL Estimated Date of Delivery: 08/17/22  31w 1 D  preterm male born 1.52 kg