CHIEF COMPLAINT: Increased BP and anxiety at term pregnancy

PRESENT ILLNESS: 35 yo G4P1 @38+0wks presents to L+D for IOL given gHT, SGA.
Testing on day of admission showed EFW 2374g (10%).  Booking BP
108/56; has had BP elevated to 130-140s/80-90s since 34wks.  BPs
on day of admission was comparable.  No HA, visual changes, RUQ
pain.  Slightly uncomfortable ctxs, no LOF, no VB. +AFM.

MEDICAL HISTORY: POBhx:
[**2122**] - SAB -> D&C
[**2126**] - Term SVD after IOL for ?gHTN
[**2129**] - SAB -> no D&C

MEDICATION ON ADMISSION: PNV

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: BP 142/76, HR 101
NAD, anxious
CTAB
RRR
Abd - NT, gravid, EFW 6#
L.Ext - NT, nonedematous, DTRs 2+ b/l
SVE: [**1-/2074**]/-2
FHT 140s/moderate variability/+accels/-decels
Toco: q2-4min

FAMILY HISTORY: 

SOCIAL HISTORY: Married
no cig/EtOH/recreational drugs
Premature separation of placenta, delivered, with or without mention of antepartum condition,Anemia of mother, delivered, with mention of postpartum complication,Iron deficiency anemia secondary to blood loss (chronic),Major puerperal infection, delivered, with mention of postpartum complication,Secondary uterine inertia, delivered, with or without mention of antepartum condition,Other immediate postpartum hemorrhage, delivered, with mention of postpartum complication,Unspecified inflammatory disease of uterus,Transient hypertension of pregnancy, delivered , with or without mention of antepartum condition,Poor fetal growth, affecting management of mother, delivered, with or without mention of antepartum condition,Elderly multigravida, delivered with or without mention of antepartum condition,Outcome of delivery, single liveborn,Carrier or suspected carrier of group B streptococcus
Prem separ placen-deliv,Anemia-delivered w p/p,Chr blood loss anemia,Maj puer inf NOS-del p/p,Sec uterine inert-deliv,Postpa hem NEC-del w p/p,Uterine inflam dis NOS,Trans hyperten-delivered,Poor fetal growth-deliv,Elderly multigravida-del,Deliver-single liveborn,Group b streptoc carrier
Admission Date:  [**2130-8-22**]              Discharge Date:   [**2130-8-29**]

Date of Birth:  [**2095-8-8**]             Sex:   F

Service: OBSTETRICS/GYNECOLOGY

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 64725**]
Chief Complaint:
Increased BP and anxiety at term pregnancy

Major Surgical or Invasive Procedure:
Primary cesarean section
Exploratory laparotomy, management of retro-peritoneal bleed


History of Present Illness:
35 yo G4P1 @38+0wks presents to L+D for IOL given gHT, SGA.
Testing on day of admission showed EFW 2374g (10%).  Booking BP
108/56; has had BP elevated to 130-140s/80-90s since 34wks.  BPs
on day of admission was comparable.  No HA, visual changes, RUQ
pain.  Slightly uncomfortable ctxs, no LOF, no VB. +AFM.


Past Medical History:
POBhx:
[**2122**] - SAB -> D&C
[**2126**] - Term SVD after IOL for ?gHTN
[**2129**] - SAB -> no D&C

PGynHx: No abnl paps, no STIs

PMH: Anxiety, +PPD with neg CXR s/p INH in [**2121**]

PSH: ear tubes, D&C



Social History:
Married
no cig/EtOH/recreational drugs


Physical Exam:
BP 142/76, HR 101
NAD, anxious
CTAB
RRR
Abd - NT, gravid, EFW 6#
L.Ext - NT, nonedematous, DTRs 2+ b/l
SVE: [**1-/2074**]/-2
FHT 140s/moderate variability/+accels/-decels
Toco: q2-4min


Pertinent Results:
[**2130-8-22**] 07:33PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2130-8-22**] 07:33PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.005
[**2130-8-22**] 07:33PM   PLT COUNT-226
[**2130-8-22**] 07:33PM   WBC-9.1 RBC-3.92* HGB-11.7* HCT-34.1* MCV-87
MCH-29.9 MCHC-34.4 RDW-14.5
[**2130-8-22**] 07:33PM   URIC ACID-5.5
[**2130-8-22**] 07:33PM   ALT(SGPT)-16
[**2130-8-22**] 07:33PM   CREAT-0.5

Brief Hospital Course:
Pt was admitted for induction of labour for gHTN and SGA infant.
 Pt was started on pitocin per protocol, given that she was
contracting too often for cytotec.  Over the course of HD#1 and
2, pt had occasional variable decels for which the pitocin was
adjusted accordingly.  On HD#2, pt had an arrest of dilation at
8cm and a 300cc clot noted in vaginal vault.  For arrest of
dilation and suspected abruption, pt was informed of risks and
benefits of C/S, and agreed to LTCS.  The details of the
procedure is available in an operative report elsewhere.

POD#0 s/p LTCS, pt was tachycardic to 130s and with low UOP.  Pt
also pale, weak and nauseated.  Hct trended down from preop 34
to 25 postop, and subsequently down to 18.  Pt had no vaginal
bleed, FF, and slightly distended abd.  With concern for
intrabdominal bleeding, pt was given 2uPRBC and OB hemorrhage
protocol was initiated.  Pt returned to the OR for exploartory
laparotomy with Gyn Oncologist called to assist.  s/p ex-lap, R
uterine artery ligation (details of this surgery is available in
an operative report elsewhere), pt was transfered to the ICU for
further management, where she remained intubated and required
pressors to control BPs.  Pt also required an additional 3u PRBC
and 4u FFP.

POD#1 s/p ex lap R uterine artery ligation s/p LTCS, pt was
extubated and off pressors.  UOP was monitored closely and
bolused as needed.  Hct had increased back up to 27.8, and
received another unit of PRBC, after which her hct stablized
throughout the rest of her hospital stay around 27-28.  Lytes
were repleted prn.

Pt was transfered back to the postpartum floor later the same
day, where she c/o SOB and calf pain, with O2sat down to 87% on
RA, although it increased up to 91% with deep breaths.  In
setting of postop, immobililty, though SCD in place, with
concern for DVT/PE, LENIs and CTA were obtained.  LENIs negative
for DVT, CTA negative for PE, but showed moderate b/l pleural
effusions, mild intersitial fullness c/w fluid overload,
atelectasis.  On POD#2, given increased sx of SOB and with rales
[**1-17**] from base of lungs b/l, IVF were turned down and lasix 20mg
x1 provided.  A second dose of lasix was subsequently given, and
pt improved further through POD#3.

On POD#3, pt's BPs were noted to be elevated, for which
preeclampsia labs were sent and labetalol was started at 200mg
[**Hospital1 **].  Labs were found to be wnl, and BPs were monitored closely
through POD#[**3-20**], and were well controlled on labetalol.  Pt's
staples were removed on POD#6.

Pt was discharged home in good condition, tolerating po,
ambulant, with good pain control and adequate BP control.

Medications on Admission:
PNV

Discharge Medications:
1. Percocet 5-325 mg Tablet Sig: One (1) Tablet PO every [**4-20**]
hours as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
2. Colace 100 mg Capsule Sig: One (1) Capsule PO three times a
day.
Disp:*90 Capsule(s)* Refills:*2*
3. Labetalol 200 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
4. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia for 10 days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Pregnancy complicated with terminal gestational HTN, abruptio
placentae, Retroperitoneal hemorrhage,


Discharge Condition:
stable


Discharge Instructions:
Follow detailed discharge planning instructions.
Call for fever, heavy bleeding, depression, mastitis etc

Followup Instructions:
2 weeks post partum and 6 weeks post-partum



Completed by:[**2130-9-14**]
{'Premature separation of placenta, delivered, with or without mention of antepartum condition,Anemia of mother, delivered, with mention of postpartum complication,Iron deficiency anemia secondary to blood loss (chronic),Major puerperal infection, delivered, with mention of postpartum complication,Secondary uterine inertia, delivered, with or without mention of antepartum condition,Other immediate postpartum hemorrhage, delivered, with mention of postpartum complication,Unspecified inflammatory disease of uterus,Transient hypertension of pregnancy, delivered , with or without mention of antepartum condition,Poor fetal growth, affecting management of mother, delivered, with or without mention of antepartum condition,Elderly multigravida, delivered with or without mention of antepartum condition,Outcome of delivery, single liveborn,Carrier or suspected carrier of group B streptococcus'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Increased BP and anxiety at term pregnancy

PRESENT ILLNESS: 35 yo G4P1 @38+0wks presents to L+D for IOL given gHT, SGA.
Testing on day of admission showed EFW 2374g (10%).  Booking BP
108/56; has had BP elevated to 130-140s/80-90s since 34wks.  BPs
on day of admission was comparable.  No HA, visual changes, RUQ
pain.  Slightly uncomfortable ctxs, no LOF, no VB. +AFM.

MEDICAL HISTORY: POBhx:
[**2122**] - SAB -> D&C
[**2126**] - Term SVD after IOL for ?gHTN
[**2129**] - SAB -> no D&C

MEDICATION ON ADMISSION: PNV

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: BP 142/76, HR 101
NAD, anxious
CTAB
RRR
Abd - NT, gravid, EFW 6#
L.Ext - NT, nonedematous, DTRs 2+ b/l
SVE: [**1-/2074**]/-2
FHT 140s/moderate variability/+accels/-decels
Toco: q2-4min

FAMILY HISTORY: 

SOCIAL HISTORY: Married
no cig/EtOH/recreational drugs 

### Response:
{'Premature separation of placenta, delivered, with or without mention of antepartum condition,Anemia of mother, delivered, with mention of postpartum complication,Iron deficiency anemia secondary to blood loss (chronic),Major puerperal infection, delivered, with mention of postpartum complication,Secondary uterine inertia, delivered, with or without mention of antepartum condition,Other immediate postpartum hemorrhage, delivered, with mention of postpartum complication,Unspecified inflammatory disease of uterus,Transient hypertension of pregnancy, delivered , with or without mention of antepartum condition,Poor fetal growth, affecting management of mother, delivered, with or without mention of antepartum condition,Elderly multigravida, delivered with or without mention of antepartum condition,Outcome of delivery, single liveborn,Carrier or suspected carrier of group B streptococcus'}
