The prenatal clinic nurse has received four phone calls. Which patient should be called first?

Question

1. Primip at 28 weeks with history of asthma reporting difficulty breathing and shortness of breath
2. Multip at 6 weeks with a seizure disorder inquiring what foods are good folic acid sources for her
3. Primip at 35 weeks with a positive HBsAG wondering what treatment her baby will receive after birth
4. Multip at 11 weeks with untreated hyperthyroidism describing the onset of vaginal bleeding

Answer 1

Correct Answer: 1
Rationale 1: Asthma exacerbations are most common between 24 and 36 weeks. Asthma attacks can lead to maternal hypoxia, which can lead to fetal hypoxia. This patient is the top priority.
Rationale 2: Women with seizure disorders should be started on folic acid supplements prior to pregnancy, and should continue throughout pregnancy. This patient is not the highest priority.
Rationale 3: A patient with a positive HBsAG is contagious for hepatitis B. The risk of transmission to the fetus at birth is reduced by bathing the neonate as soon as possible after birth and giving the infant immunoprophylaxis and the first HBsAG vaccine dose. The patient seeking information about what will happen after delivery is a low priority when there are pregnant patients currently experiencing physiologic problems.
Rationale 4: Pregnant women with untreated hyperthyroidism have an increased risk of fetal loss. Vaginal bleeding at 11 weeks could indicate that spontaneous abortion is taking place. But the majority of spontaneous abortions prior to 12 weeks' gestation are complete and without complications. This patient is not experiencing a normal pregnancy, but the health of both mother and fetus are not in immediate danger.