Case study: Cryptic Pregnancy (Case Study Sample)

Week 4 Discussion
The given case study involves Juanita Morales, who is a 47-year-old G5. P5 LC 6, a Hispanic female who presents to the office complaining of lower abdominal cramping and urinary leakage for the past day. The patient states that the abdominal cramping, suprapubic, began several hours ago, is sharp, intermittent, and getting more frequent and painful. The update indicates that the patient demonstrated single live intrauterine pregnancy at 38 weeks gestation in the vertex presentation. EFW 5’2”. On admission, she was diagnosed with premature rupture of the membranes and subsequently went on to deliver a healthy male infant 4 hours later.
Primary Diagnosis: Cryptic Pregnancy
A cryptic pregnancy, also known as stealth pregnancy is not common, but conventional medical test method does not detect it. The pregnancy is detected around seven and eight months. However, some women are even surprised by labor pains as their first real sign of pregnancy (Nto-Ezimah et al., 2020). When a patient has cryptic pregnancy, nothing sets off the chain of events experienced by a normal pregnant woman. Early pregnancy symptoms such as nausea, indigestion, or stomach flu are dismissed. Low levels of pregnancy hormones can make the pregnancy symptoms mild or close to impossible to notice. Several scenarios contribute to an undetected pregnancy, lack of pregnancy symptoms, irregular menstrual cycle, bleeding and spotting, age and fertility issues, presence of polycystic ovary syndrome (PCOS), which causes hormonal imbalances, and birth control use (Nto-Ezimah et al., 2020). After delivery, the patient might experience anxiety, doubt, or fatigue (perinatal depression), but it is expected, and the condition is family treatable. According to Bai et al. (2016), fatigue is a primary concern during pregnancy. The patient's pertinent positives include lower back pain, abdominal discomfort, gas, dilated cervix, and subsequent delivery delivery of a healthy male child.
Differential Diagnosis
Stress incontinence: Stress urinary incontinence (SUI) is a disorder that is characterized by embarrassment leading to isolation. One out of every three women will develop stress urinary incontinence (SUI) at some point. SUI impacts the quality of life for many women. SUI is occasioned by involuntary leakage of urine due to increased abdominal pressure. Several factors increase SUI incidence, including age, body mass index, parity, pelvic surgery, menopause, caffeine use, smoking, and comorbid conditions. However, some of these factors are modified through lifestyles changes. In the above case study, pertinent positives of stress incontinence comprises urine leakage and obesity.
Anemia: Pregnancy exacerbates the risk of iron defiency anemia, a condition in which the body does not have enough healthy red blood cells to carry adequate oxygen to its tissues.. During pregnancy, the body needs double the amount of iron that nonpregnant women need to make more hemoglobin (Smith et al., 2019). Inadequate iron stores can increase the risk of developing iron deficiency anemia.The patient is at-risk of anemia which is indicated by low hemoglobin (10.2) and HCT (29.8). Furthermore, the patient complains of fatigue and has lost blood during child birth.
Additional Questions
I would ask the patient about her family medical history and interview her mother, father, siblings, and grandparents on both sides' medical history, such as hypertension, diabetes, reproductive health conditions. Understanding the patient's family medical history helps identify patients with a higher than usual chance of having common disorders influenced by genetic factors, environmental conditions, and lifestyle choices. According to Nichol and Nelson (2018), medical history may also direct to differential diagnoses. I would also ask about the patient's social history. Where do they live? Who do they live with? What sort of work do they do? What is their education level? What is their income? The rationale for asking the patient these questions is to understand the environmental factors that may impact their health condition. For example, education level help know if the patient can make good decisions about their health. Also, I will ask if the patient has experienced any vomiting or nausea, which are some of the significant symptoms of pregnancy.
Plan
Diagnostics:
But TSH (Thyroid Stimulating Hormone) test can be performed after delivery to determine thyroid function. Proper thyroid function is key for preventing perinatal mood and anxiety disorders (such as postpartum anxiety and postpartum depression), maintaining proper energy levels, and maintaining metabolic rates. Between 5-10% of women will experience postpartum thyroiditis. This number could be higher and many women are left undiagnosed and therefore untreated. Another test that can be ordered is prolactin; a vital hormone made by the pituitary gland and is known for its production of breastmilk. Monitoring prolactin will help maximize milk production for as long as breastfeeding is desired by mom and baby.
Pharmacological and Non-pharmacological Management
Pharmacological treatment will include analgesia to favor the patient's recovery, reduce maternal distress and increase the mother's interactions with the newborn. Analgesia will be preferred because there are painful symptoms in distinct regions suc