The nurse in the obstetrical clinic is setting appointments for patients seeking preconceptual care. Which patient should be seen first?
1. 36-year-old, has never been pregnant, takes medication for a seizure disorder
2. 15-year-old, smokes one pack per day, had a miscarriage four months ago
3. 22-year-old, runs long distances, has been on the pill for six years
4. 29-year-old, has had two abortions, takes a multiple-vitamin supplement
Correct Answer: 1
Rationale 1: This patient is the top priority because she has multiple risk factors: She is over the age of 35 and therefore is at risk for trisomies; some medications are teratogenic and are contraindicated during pregnancy; and pregnancy is not recommended for women with some conditions. This patient needs to see the specialist who prescribes her anti-seizure medication, as well with an obstetric provider, to discuss the risks her age presents to a possible pregnancy.
Rationale 2: Although this patient has the risks of being young and a smoker, she is not the highest priority.
Rationale 3: The only risk factor this patient has is a need to increase folic acid intake due to being on the pill for six years.
Rationale 4: This patient has no risk factors for pregnancy. A history of more than three abortions increases the risks of preterm labor and infertility, but this patient has only had two abortions.
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