25yo G1P0 presents for TOB visit, currently around 20wks gestation. The issue with this case was how to figure out her EDC. There was not an EDC noted in her medical record, the patient was not really sure when she had her LMP. When we tried to calculate the EDC by using her best estimate date; there was a 5-day difference from when it was calculated using Naegle. She didn’t get an US until she was about 16 wks; and the EDC listed on the US report was 7 days off. So which EDC should you use? My preceptor decided on using the EDC obtained from the wheel. There was no real rhyme or reason why she chose that EDC. On top of that she continued to smoke a pack a day and her husband was due to get a dishonorable discharge from the Air Force within the next month. So she would be without healthcare. Unfortunately during my first week of OB/GYN clinical, it seems that this kind of drama is all too common. The challenge that we have is how to manage patients with personal issues that make it difficulty to provide optimal healthcare.
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Unfortunately, because of the demographics of the military, I think this kind of case will be seen all too often. I find it frustrating to deal with non-compliant patients who fail to see the impoirtance of monitoring their health not to mention the health of the unborn child. The phenomenon of separation from the military in the midst of medically managing a patient is also somewhat troublesome, especially with a patient that generally fails to cooperate with routine medical management.
ReplyDelete2 thoughts here-as to the discrepancy between LMP and U/S EGA dating, practice here at Fort Hood is if the 2 dates "disagree" by less than 9 days, EGA is based on LMP, even if unsure of "exactness" of date. If dates differ by 9/+ days then U/S dating is used to determine EGA/EDC.
ReplyDeleteAs to the service member ETS and loss of/change in health care/insurance availability for the dependent pregnant spouse, if an honorable/voluntary ETS, service member can pay to extend his/her health care up to 180 days (DOD-wide) to cover mom/baby, and/or the ETS service member can make sure they have a job/other health insurance capability they can pay for/obtain to start coverage on day of ETS. If Dishonorable D/C with involuntary ETS-last resort if servicemember unable to secure job/alternative health insurance/care, mom/baby can be covered under Medicaid.
Totally agree on all the "other issues" that need attention when working in clinic with OB patients-Fort Hood has 2 big groups of deployers leaving very soon-one group in Aug/Sep and the second in December. Seems like over 50% of our Women's Health Clinic pts have unmet/unplanned for psycho-social needs, on top of their maternal-fetal care needs, and only 40 (NOB) to 20 (ROB) minutes to cover all the "important stuff"-whew!