Lauren is a 29-year-old woman who is in her 37th week of pregnancy. Lauren’s past medical history is unremarkable with no underlying medical conditions, and her pregnancy had been uncomplicated. Over the past three days Lauren has noticed a decrease in foetal movements, which has started to worry her. Lauren’s partner, Michael, suggested that she go to the hospital as the decrease
Lauren is a 29-year-old woman who is in her 37th week of pregnancy. Lauren’s past medical history is unremarkable with no underlying medical conditions, and her pregnancy had been uncomplicated. Over the past three days Lauren has noticed a decrease in foetal movements, which has started to worry her. Lauren’s partner, Michael, suggested that she go to the hospital as the decrease in the baby’s movements could indicate a problem. At hospital, Lauren was examined by a doctor and found to have a slightly raised temperature of 37.4 °C. A cardiotocograph (CTG) was performed and the test result was revealed to be reactive, which was reassuring for Lauren as it meant that after her baby had some movements, the heart rate increased as expected. Because the CTG was determined to be normal, Lauren was allowed to return home but was advised to call or return if she was concerned. Three days later Michael drove Lauren to the hospital. Lauren was feeling very unwell and thought that she could have a viral infection such as influenza. Lauren had a headache, she was shivering and feeling cold, her back was aching, and she had a fever. Lauren also felt sick in the stomach, but she had not vomited at all. Upon examination, Laruen was found to have a temperature of 38.5 °C and some loin tenderness on her right-hand side. Lauren was diagnosed with likely pyelonephritis, however, the doctor said that someone would come and ask some routine questions about the sorts of foods Lauren had eaten recently just to rule out a possible foodborne cause. In the interim, both blood and urine samples were collected for culturing, and Lauren was commenced on amoxicillin administered intravenously. A food history was taken for Lauren, which was quite challenging as the questions spanned the past four weeks. For the most part, Lauren and Michael had been eating healthy meals freshly prepared at home and had not eaten out at all or purchased ready-to-eat foods. Lauren was somewhat aware of the need to avoid high risk foods during pregnancy so had not eaten any ham, soft cheeses, or foods containing raw eggs. The only time that she had been out for a meal recently was for her baby shower, which was held three and a half weeks ago. At the baby shower she avoided the cheese and charcuterie board and instead opted for vegetables and homemade dips, cold chicken sandwiches, pre-cut fruits, and a fruit/leafy green smoothie. There were no reports of anyone falling sick after the baby shower, although Lauren’s aunt did mention that she had a bout of diarrhoea a day or so later, but her aunt didn’t think that it was linked to the baby shower at all. Lauren remained in hospital overnight and the following day her temperature had settled back to normal. Lauren’s urine culture returned a negative result, but the blood culture revealed bacterial growth under both aerobic and anaerobic incubation. At around this time Lauren’s membranes spontaneously ruptured and labour soon followed. The amniotic fluid was observed to be clear. Lauren progressed to a normal delivery of a baby boy (birth weight 3062 g, with Apgar scores of 8 and 10 at 1 and 5 minutes, respectively). Lauren’s positive blood culture was followed up by the
the answer is not Pyelonephritis or Diarrhoea. Pregnancy and premature birth is a big clue
What disease do you think that Lauren had and why have you come to this conclusion?
What diagnostic test(s) would you have performed to confirm the disease diagnosis?
What is the treatment that Lauren should be receiving for this disease? Are there any implications for Lauren’s baby based on her diagnosis?
Step by step
Solved in 2 steps
