A 43-year old woman comes to clinic saying that she hasn’t been feeling well for the past three weeks. She reports headaches, nausea, breast tenderness, abdominal bloating, and extreme fatigue. She is concerned that she has a horrible illness. She has had no cold symptoms, fever, vomiting, urinary symptoms, chest pain, or trouble breathing. Her husband says he’s worried because she’s “tired all the time”.
On exam, the woman looks well. Her vital signs are normal. A dipstick of her urine is unremarkable but her urine pregnancy test comes back positive.
Upon hearing the news, the patient and her husband are completely shocked. She says they have a 20 year old daughter who was conceived using fertility treatments. She has been unable to get pregnant since. She says her periods are irregular and are often spaced 6 months apart. She thought she was entering menopause.
This patient had many of the hallmark symptoms of pregnancy including headaches, nausea, fatigue, breast tenderness, and bloating but given her age and her history of infertility, pregnancy was the last thing on her mind.
There is no doubt that it becomes increasingly difficult to conceive as a woman ages, but there are stories of women, like this patient, who conceive spontaneously in their 40s. Older women can certainly have perfectly healthy babies, but the risk of miscarriage and pregnancy complication is considerably higher. Therefore, early prenatal care is particularly important.
The patient had an ultrasound the next morning which demonstrated a single fetus with a heartbeat estimated at 6 weeks. She is scheduled to see a clinical nurse midwife in one week. In the meantime, she was instructed to take a daily prenatal vitamin, avoid alcohol, and limit her caffeine intake.
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