early adulthood years
March 17, 2021
3 page essay 29
March 17, 2021

Is this patient mentally fit for a child if it were to work out? Do they have a plan for the care of the child in their advanced age?

Is this patient mentally fit for a child if it were to work out? Do they have a plan for the care of the child in their advanced age?

Miranda Stennett and Jessica Strzynski Group C Interactive Case Study 1 75-year-old nullipara female wanting to pursue IVF with her fiancé. Patient has history of hypertension and is on Zocor, Plavix, and lisinopril which are unsafe to take during a pregnancy. People with hypertension prior to a pregnancy are at a higher risk for developing preeclampsia during pregnancy, not to mention her age which is another risk factor for this patient (Umesawa & Kobashi, 2017). Patient is up to date on her screenings and is in good overall health with no use of tobacco drugs and occasional alcohol. Patient follows back up after successful IVF implantation and has elevated BP 160/92 and 160/88. She also has edema in her legs and face. Her lab work shows her liver enzymes are elevated and her platelets are low which are signs of HELLP. Other signs of HELLP include kidney failure, placental abruption, cardiovascular and cerebrovascular diseases, DIC, and hemolysis (Kongwattanakul et al., 2018). Differential Diagnosis Preeclampsia- patient is at a high risk for this due to increased maternal age, chronic hypertension prior to pregnancy, and IVF (Kongwattanakul et al., 2018). HELLP Syndrome- patient appears to have the symptoms for this syndrome and should be admitted to the hospital for treatment right away. Pre-existing Essential Hypertension complicating pregnancy- hypertensive disorders, an umbrella term including preexisting and gestational hypertension, preeclampsia, and eclampsia impose complications in up to ten percent of pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality (Braunthal & Brateanu, 2019). This patient had pre-existing chronic hypertension taking several medications for control. Chronic hypertension is a strong risk factor for severe and preterm eclampsia (Villa et al., 2017). Treatment The patient should be admitted to the hospital and start on Magnesium IV to prevent convulsions and labetalol to decrease BP. Patient should have further lab workups including urine checked for protein and a CMP. The patient could also be treated with eculizumab for added protection of kidneys and maternal endothelium (Lokki et al., 2020) Patient did have a placental abruption and delivered her baby who only survived 20 minutes out of the womb. Patient did have some residual kidney issues from HELLP and had some issues with stabilizing out her blood pressures after delivery. She was discharged home in stable condition. The patient should be given the option to follow up with a therapist to help her cope with her loss. The patient should follow up with maternal fetal medicine and her OBGYN to discuss risks of additional attempts. Patient should be discouraged from IVF again as it caused her body residual damage. Follow up should be done with her PCP who also should set up patient counseling to see if there is an underlying behavioral health/mental health issue. There are several ethical issues that were present in this scenario including maternal age being at the top of the list. Postmenopausal women still have the right to personal discretion in terms of reproduction but have various challenges are associated for both the woman and the offspring (Osazee & Omozuwa, 2018). In women over 43 years of age, there is only a 5% that a normal chromosomal blastocyte is produced (Ubaldi et al., 2019). Psychological issues include in depth discussions and counseling explaining the risks of advanced maternal age pregnancy especially post-menopausal. These risks include a higher risk for miscarriage, congenital and chromosomal abnormalities, still birth, preterm delivery, placental abruptions, and placenta previa (La, 2020). Is this patient mentally fit for a child if it were to work out? Do they have a plan for the care of the child in their advanced age? Physical health issues that can present with advanced maternal age such as this patients, is the increased chance of bone fractures during birth, physical demand and strain on the cardiovascular system, and complications with the lymphatic system (Pettersson, Nedstrand, Bladh, Svanberg, Lampic, & Sydsjo, 2020). Financial issues that would be considered for this patient would be high due to the limited income available. Further financial burdens will be the bills from IVF and hospital bills from pregnancy complications. On average, middle-class living families will spend an average of 233,610 by the time the child turns 18 (U.S. Department of Agriculture, 2020). References Braunthal, S., & Brateanu, A. (2019). Hypertension in pregnancy: Pathophysiology and treatment. SAGE open medicine, 7, 2050312119843700. https://doi.org/10.1177/2050312119843700 Kongwattanakul, K., Saksiriwuttho, P., Chaiyarach, S., & Thepsuthammarat, K. (2018). Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome. International journal of women’s health, 10, 371. doi: 10.2147/IJWH.S168569 La, O. (2020). Motherhood after menopause; successful postmenopausal pregnancy at federal medical centre, yenagoa: a case report. Niger Delta Journal, 36. Retrieved from https://nmabayelsa.org/wp-content/uploads/2020/05/NMA.pdf#page=50 Lokki, A. I., Haapio, M., & Heikkinen-Eloranta, J. (2020). Eculizumab Treatment for Postpartum HELLP Syndrome and aHUS—Case Report. Frontiers in Immunology, 11, 548. Retrieved from https://doi.org/10.3389/fimmu.2020.00548 Osazee, K., & Omozuwa, E. S. (2018). Postmenopausal motherhood and IVF: The ethical challenge. Annals of Biomedical Sciences, 17(2), 61-64. Retrieved from https://www.ajol.info/index.php/abs/article/view/175592 Pettersson, M. L., Nedstrand, E., Bladh, M., Svanberg, A. S. Lampic, C., & Sydsjo, G. (2020). Mothers who have given birth at an advanced age – health status before and after childbirth. Sci Rep 10, 9739 (2020). https://doi.org/10.1038/s41598-020-66774-4 Ubaldi, F. M., Cimadomo, D., Vaiarelli, A., Fabozzi, G., Venturella, R., Maggiulli, R., … & Rienzi, L. (2019). Advanced maternal age in IVF: still a challenge? The present and the future of its treatment. Frontiers in endocrinology, 10, 94. Retrieved from https://doi.org/10.3389/fendo.2019.00094 Umesawa, M., & Kobashi, G. (2017). Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors, and prognosis. Hypertension Research, 40(3), 213-220. Retrieved from https://doi.org/10.1038/hr.2016.126 U.S. Department of Agriculture. (2020). The cost of raising a child. Available from: https://www.usda.gov/media/blog/2017/01/13/cost-raising-child Villa, P. M., Marttinen, P., Gillberg, J., Lokki, A. I., Majander, K., Maija-Riitta Ordén, . . . Laivuori, H. (2017). Cluster analysis to estimate the risk of preeclampsia in the high-risk prediction and prevention of preeclampsia and intrauterine growth restriction (PREDO) study. PLoS One, 12(3) doi: http://dx.doi.org.ezp.waldenulibrary.org/10.1371/journal.pone.0174399


 


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