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26 y.o. G2P1001 at 33wk by 9wk US (Estimated Date of Delivery: 5/6/19) presents for initial OB visit. She is a self transfer of care from Eskenazi Hospital where she was seeing MFM for positive ANA and SSA antibodies. Patient was initially evaluated for skin lesions on her ankles consistent with livedo reticularis. Workup was negative for APLS abs, anti-dsDNA abs, but positive for SSA antibodies. She was placed on Plaquenil and aspirin and has had serial fetal echos from 16 to 28 weeks to monitor for congenital heart block.
1. ANA positive R76.8
Positive ANA, SSA. C3/C4 WNL and DsDNA neg. Antiphospholipid panel neg 9/2018
- Tested after presenting with a rash thought to be most c/w livedo reticularis
- Positive ANA and SSA, with suspicion for Discoid Lupus
- Antiphospholipid Syndrome workup on 9/7/18 negative: lupus anticoagulant absent, anticardiolipin IgG 8 (less than cutoff of 40), and anti B2 glycoprotein IgG 4 (not >99%ile); DNA-ds: normal
- Baseline HELLP labs: Plt 363, Cr 0.61, AST/ALT 13/18, Uric acid 2.8, P:C 0.05
- Given +SSA, patient had weekly fetal echocardiograms between 16 and 26-28wks given the 2% risk of fetal heart block; schedule for last echo 3/26.
- S/p Rheumatology (2/6/19): recommended continuing daily Plaquenil 300mg and ASA.
- Has Opthalmology appoint scheduled in May
-Plan for delivery by 39 weeks.
2. Pregnant Z33.1
FWB
- Dating by L=9
- US 10/5: 9w4d, posterior placenta, CRL 29.2mm, normal amount of amniotic fluid
- NT:10/24: 12w2d, NT 1.48mm, CRL 61.9mm, posterior placenta; second portion of sequential screen wnl
- Ex US 12/11: cephalic, post plac, 3vc, AFI wnl, EFW 297g (66%), anatomy wnl. Growth US on 2/13 AGA. 3/18 efw 25%.
- s/p normal fetal ECHO, plan for repeat on 3/26
PNL: B+, ab-, RI
- GTT and 3rd trimester wnl
- s/p Flu shot 10/2
- tdap 3/4
PPplans: counseled on LARCs. She declines Depo, Nexplanon and IUDs. She desires OCPs. As her workup was negative for APLS she is a candidate for estrogen containing OCPs.
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