Late Presentation to Prenatal Care.

A collection of Curbside Consultation published in AFP is available at http://www.aafp.org/afp/ curbside. Case Scenario A 26-year-old gravida 2, para 1 Dominican woman presents to my clinic for a prenatal visit. She is unsure of her due date and states that her last menstrual period was about seven or eight months ago. She received some prenatal care in the Dominican Republic, although she does not have any records from her physician. She reports that she has had an uncomplicated pregnancy so far, and that an earlier ultrasonography indicated that she is going to have a boy. Her medical history is unremarkable aside from a full-term cesarean delivery performed in the Dominican Republic four years ago because of “a cord around the baby’s neck.” She is taking a daily prenatal vitamin. On examination, her vital signs are unremarkable, her fundal height measures 31 cm, the fetal heart rate is 140 beats per minute, and the fetus is cephalic by Leopold maneuvers. She has a 16-cm transverse scar along her waistline and a circular 3-cm scar on her right shoulder over the deltoid. She completed an application for health insurance with the clinic’s social worker just before her visit with me. How can I best minimize risks and optimize health for this patient presenting late to prenatal care?