New Prenatal Consult

Thank you for your referral of Sarah Jenkins, a 36-year-old G2P1 currently at 20+2 weeks gestation.

Estimated date of confinement is 15/08/2026 based on a dating ultrasound completed at 8+4 weeks.

Referred for routine obstetrical care and management of gestational diabetes mellitus (GDM).

This Pregnancy

• Advanced maternal age (36 years)
• Early GDM diagnosed at 16 weeks
• Elevated maternal BMI (32.4 kg/m²)
• First-trimester nausea and vomiting, now resolved

Past Obstetrical History

• 2022: SVD at 39+1 weeks, male infant 3,850 g, pregnancy complicated by diet-controlled GDM, no postpartum complications.

Medical History

Medical Conditions:

• Hypothyroidism
• Mild intermittent asthma

Current medications:

• levothyroxine (Synthroid®) 75 mcg PO daily
• salbutamol (Ventolin®) 100 mcg INH PRN
• prenatal multivitamin (PregVit®) 1 tablet PO daily
• doxylamine-pyridoxine (Diclectin®) 10 mg/10 mg PO BID (discontinued at 14 weeks)

Allergies: amoxicillin (maculopapular rash)

Surgical history:

• Laparoscopic appendectomy (2015)
• Excision of right breast fibroadenoma (2018)

Gynecological history:

• No history of STIs
• Most recent Pap test (12/05/2024): NILM

Social History

Smoking: Non-smoker (never smoked)

Alcohol: None during pregnancy; social drinker pre-pregnancy

Substances: Denies recreational or illicit substance use

Occupation: Elementary school teacher

Support system: Lives with supportive husband; parents live locally and assist with childcare

Community: Edmonton, AB

Physical Examination

BP: 118/74 mmHg HR: 78 bpm Weight: 88.5 kg Height: 165 cm

BMI: 32.4 kg/m²

Symphysis-fundal height: 20 cm

Fetal presentation: Breech

Fetal heart rate: 145 bpm

CVS: S1, S2 normal, no murmurs Resp: Clear to auscultation bilaterally Abdomen: Soft, non-tender, gravid, well-healed laparoscopic scars Extremities: No peripheral edema

Prenatal Investigations

Blood type: O positive, antibody screen negative Hepatitis B surface antigen: Non-reactive Hepatitis C antibody: Non-reactive HIV 1/2 antigen/antibody: Non-reactive Syphilis serology (EIA): Non-reactive Rubella IgG: Immune Varicella IgG: Immune CBC: Hb 121 g/L, WBC 8.4 x 10^9/L, Plt 245 x 10^9/L TSH: 1.8 mIU/L 50 g GCT (15 weeks): 9.2 mmol/L 75 g OGTT (16 weeks): Fasting 5.4 mmol/L, 1-hour 10.8 mmol/L, 2-hour 8.6 mmol/L (Diagnostic for GDM)

Maternal serum screening / NIPT: First Trimester Combined Screening low risk for Trisomy 21 (1:4,500) and Trisomy 18 (< 1:10,000).

Urine culture (10 weeks): No growth; Routine urinalysis: Negative for protein and glucose.

Edinburgh Postnatal Depression Scale (EPDS): 4/30

Ultrasounds

10/12/2025 (8+4 weeks): Single live intrauterine gestation, CRL consistent with 8+4 weeks. 24/01/2026 (12+2 weeks): NT 1.4 mm, nasal bone present, normal early anatomy. 25/03/2026 (19+6 weeks): Breech presentation, posterior placenta > 2 cm from internal os, normal complete fetal anatomy, EFW 330 g (55th percentile), normal amniotic fluid volume, BPP 8/8.

Vaccination

We discussed the vaccines recommended during pregnancy.

She received the inactivated influenza and COVID-19 vaccines in October 2025, and plans to receive the Tdap vaccine between 27 and 32 weeks at her local community pharmacy.

Impression

• High-risk pregnancy secondary to early-onset GDM and advanced maternal age
• Hypothyroidism, currently euthyroid on replacement

Plan

• Transfer of obstetrical care to my clinic for ongoing prenatal management and delivery.

We discussed the obstetrical call system and reviewed that we work in a teaching hospital, where learners including medical students and residents work with our team and will most likely be involved in her care.

• Routine prenatal follow-up every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, and weekly thereafter until delivery.

• Continue diabetic diet and capillary blood glucose monitoring QID (fasting and 1-hour postprandial).

• Aim for 30 minutes of moderate-intensity walking following meals.

• Continue prenatal multivitamin (PregVit®) 1 tablet PO daily.

• Start colecalciferol (vitamin D3) 1,000 IU PO daily.

• Start acetylsalicylic acid (Aspirin®) 162 mg PO QHS until 36 weeks for preeclampsia prophylaxis given risk factors.

• Referred to the Diabetes in Pregnancy Clinic for ongoing glycemic management and endocrinology review.

• Serial fetal growth ultrasounds ordered for 28, 32, and 36 weeks gestation.

• Repeat TSH and CBC in the third trimester (28 weeks).

Thank you again for involving me in her care.