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Bijoux Case Study: High Risk Pregnancy

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Bijoux is a 33yo, G5 P2022, who is currently 19 weeks 2 days as dated by a 9-week ultrasound. She is followed in the High Risk Obstetrical Clinic secondary to HIV that was diagnosed in 2012. She currently is on Complera. She reports that she was on Complera for several years but at the beginning of the pregnancy she became so nauseous and was not keeping it down. They switched her over to Triumeq which had too many significant side effects and she was unable to tolerate it. She has since switched back to Complera and has actually been able to keep it down. Her last viral load in November was over 1 million. She does report that when she was previously on Complera and able to keep it down that her viral load was undetectable. She has an appointment with Dr. Narro for labs on February 2nd and a follow-up appointment for evaluation on February 22nd. She is here today for her anatomic survey. She did have a full sequential screen that was screen negative. On ultrasound there is a live fetus in transverse presentation. Fetal biometry is symmetric and consistent with dates. A detailed anatomic survey was unremarkable, although the spine and 4-chamber heart were…show more content…
She asked about the risk of HIV. I informed her that with a high viral load and not medication, this could be as high as 255. If she is on meds and her viral load is < 1000, the risk would be around 2-5%. I do think she has time to get her viral load under control, especially if she has previously been undetectable on Complera. I advised her to make sure that if she is nauseous that she take her Diclegis properly and then Phenergan prn for nausea. If she gets to a point where she cannot keep the Complera down, we may need to treat with Phenergan or Zofran. I scheduled her to return in 4 weeks for completion of the anatomy and growth. I also gave her notes for proof of pregnancy confirmation as well as note stating that she is unable to
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