Walden University Health & Medical Discussion

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Respond to at least two of your colleagues’ posts (from a different group) on two different days and provide additional insight that might be useful and appropriate for the issue addressed. Use your learning resources and/or evidence from the literature to support your position.


Summary of your chosen case study

Gloria Smart is a 55-year-old female who presents to your office today for regular GYN care. You read her medical history and note she received a cardiac stent at age 50, has mild hypertension, and is on Zocor, Plavix, and lisinopril. Surgical history is remarkable for tonsils as a child and bunion surgery. She works full-time, by choice, because it “makes me feel young.” She is up to date with colonoscopies. Gyn history normal pap history, last DXA within normal limits, regular mammogram. BMI is 26. First menses age 14 and menopause age 52. She works out at her local gym 5 days a week. Social history is negative for tobacco and recreational drugs. She has an occasional glass of wine. She has never married and has been with her current partner for 2 years and will be getting married in 2 months. She has never been pregnant, and her partner has never had a child.

What is your differential diagnosis?

  1. Supervision of elderly primigravida, unspecified trimester
  2. Pre-term birth
  3. Pre-existing hypertension with pre-eclampsia

Why did you make this diagnosis decision?

I chose the diagnosis of supervision of elderly primigravida, unspecified trimester due to this being her first pregnancy and age. The patient is 55 and has never been pregnant. Pregnancy at age 35 and older is considered high-risk and runs the risk of adverse maternal and perinatal outcomes. Some maternal complications are spontaneous abortion, pre-term labor, pre-eclampsia, and gestational diabetes. Fetal complications include but not limited to are autism spectrum disorder, low Agar scores, infants small for gestational age, and intrauterine growth restrictions (Glick et al., 2021). The patient has previous health issues along with her current medications which put her at an even greater risk for complications during the pregnancy.

What is your treatment plan?

  • First, the patient would need to be referred to a maternal-fetal medicine specialist.
  • There the specialist will review and reconcile all medications. She has a significant cardiac history and is at high risk for cardiovascular complications.
  • Additionally, Zocor and lisinopril are both category x drugs, and it is unknown whether Plavix is safe in pregnancy. The maternal-fetal medicine specialist will consult the cardiologist due to her cardiac issues.
  • Stop cholesterol medication.
  • Start Procardia.
  • Stop Plavix.
  • Start baby aspirin daily.
  • Start folic acid and vitamin
  • Stress test (which is good).
  • Kidney function test (normal).
  • Educate on proper diet, continue with light exercise such as walking, and discontinue drinking wine.
  • The patient will need to cut back on work to help prevent less physical stress on herself and baby

Address the ethical dilemmas and/or other issues for your case study:

Ethical issues: IVF remains ethically controversial. But this couple has the right to make whatever decision they deem is right for them. There are many reasons why IVF is so controversial. There is still much research needed in the area of IVF. Many concerns are around the embryos, the technique, and recently the safety of IVF. It has been found that upper-middle-aged women who give birth to a child after IVF are often subject to public opinion on how ‘unfitting’, ‘unnatural’, and even ‘repulsive’ this is. It is said that the most value-based arguments are the right of children to be brought up under safe conditions and women’s reproductive autonomy (Asplund, 2019).

Psychological issues: Experiencing IVF can be a source of psychological and emotional difficulties for couples trying to have a child. It can cause frustration and anger not being able to conceive. A study showed that couples trying to get pregnant can lack support from family and friends. The lack of support can hinder conception and the well-being of the couple (Malina & Pooley, 2017). Psychological issues can cause physical issues to arise.

Physical issues: The patient already has previous health issues that must be addressed before IVF. She has hypertension and has a cardiac stent placed when she was 50. With pregnancy, one can experience n/v, fatigue along with developing pre-eclampsia or gestational diabetes. The patient does work so working may be a strain on her now that she is pregnant so that will need to be talked about.

Financial issues: IVF can be very expensive. It is important to discuss medical insurance coverage when thinking about IVF. Some insurance companies in certain states will cover IVF while others may not. It is said that less than half the states in the U.S. have laws that require insurance companies to cover IVF. The average cost is said to be on average $15,000 (Ho, 2021). Financial issues can cause physical and psychological issues.

Reference

Asplund, K. (2019). Use of in vitro fertilization—ethical issues. Upsala Journal of Medical Sciences, 125(2), 192–199. https://doi.org/10.1080/03009734.2019.1684405

Glick, I., Kadish, E., & Rottenstreich, M. (2021). Management of pregnancy in women of advanced maternal age: Improving outcomes for mother and baby. International Journal of Women’s Health, Volume 13, 751–759. https://doi.org/10.2147/ijwh.s283216

Ho, J. (2021, July 8). Patient education: In vitro fertilization (IVF) (Beyond the Basics) (R. L. Barbieri & K. Eckler, Eds.). UpToDate. https://www.uptodate.com/contents/in-vitro-fertilization-ivf-beyond-the-basics

Malina, A., & Pooley, J. (2017). Psychological consequences of ivf fertilization – review of research. Annals of Agricultural and Environmental Medicine, 24(4), 554–558. https://doi.org/10.5604/12321966.1232085