CHIEF COMPLAINT: Abdominal cramping

PRESENT ILLNESS: The patient is a 32 yo G2P0 woman at 17 and [**3-23**] wks who awoke
from sleep at 4am with cramping.  The cramping has been coming
more and more frequently, and now occurs at 30 second intervals.

MEDICAL HISTORY: 1. Labs: AB Pos/ Antibody Neg/RPR NR/RI/HBSAG neg
2. Dating: By LMP and First Trimester US [**2155-3-4**]
3. Prior Ultrasounds:
[**2155-4-28**]: single uterine gestation.  placenta posterior. normal
amt
amniotic fluid, no morphologic abnormalities.  moderate anterior
perigestational bleed 6.4x2.2x11.1 cm extending to the lower
uterus consistent with marginal bleed.  no retroplacental bleed.
[**2155-5-1**]: Bedside U/S: single fetus identified and fetal HR
visualized.  clot visible anteriorly
.
PMH: only seasonal allergies
PSurgicalHx: D+C for TAB
OBHx: TAB x1
.

MEDICATION ON ADMISSION: Zantac
Tums
Reglan
Prenatal vitamins

ALLERGIES: Dilaudid

PHYSICAL EXAM: Vitals: 99.8, 80, 107/61, 18
Patient lying in bed, very uncomfortable, holding abdomen
RRR
CTAB
Abd: gravid abdomen S=D, tender over uterus superior to pubic
symphysis but otherwise non-tender without rebound/guarding.
Pelvic: Mod old blood in os.  Cx FT at ext os Long.  NT.
Extr: without edema or cords

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Non-smoker, no EtOH, no drugs or herbal supplements. She lives
with her husband. [**Name (NI) **] [**Name2 (NI) **] live in [**Country 651**].
Spontaneous abortion, complicated by delayed or excessive hemorrhage, incomplete,Defibrination syndrome,Acute respiratory failure,Iron deficiency anemia secondary to blood loss (chronic),Thrombocytopenia, unspecified,Septicemia due to escherichia coli [E. coli],Severe sepsis,Missed abortion,Hypotension, unspecified
Spon abort w hemorr-inc,Defibrination syndrome,Acute respiratry failure,Chr blood loss anemia,Thrombocytopenia NOS,E coli septicemia,Severe sepsis,Missed abortion,Hypotension NOS
Admission Date:  [**2155-5-1**]              Discharge Date:   [**2155-5-9**]

Date of Birth:  [**2123-4-6**]             Sex:   F

Service: OBSTETRICS/GYNECOLOGY

Allergies:
Dilaudid

Attending:[**First Name3 (LF) 16911**]
Chief Complaint:
Abdominal cramping

Major Surgical or Invasive Procedure:
- Uterine packing, exploratory laparotomy, uterine massage,
intrauterine injection of uterotonics, supracervical
hysterectomy, control of hemorrhage.
- Transfusion of 5 units packed RBCs, 4 units of fresh frozen
plasma, 1 unit cryoprecipitate


History of Present Illness:
The patient is a 32 yo G2P0 woman at 17 and [**3-23**] wks who awoke
from sleep at 4am with cramping.  The cramping has been coming
more and more frequently, and now occurs at 30 second intervals.

She has had three episodes of emesis since this AM, which has
not
been usual for her for the past few weeks.
*
She is also having some vaginal bleeding, though she has had
intermittent bleeding throughout the past 5 weeks, ranging from
spotting to more heavy flow.  She has been followed for
perigestational bleed growing per Ultrasound with last US [**2155-4-28**]
showing 6.4cm x 2.2cm x 11.1cm anterior bleed with no
retroplacental clot.
*
The patient was seen in the office by Dr. [**First Name (STitle) **] this AM who
found her cervix to be closed but with the lower uterine segment
slightly ballooning. Additionally she was having significant
back pain.   THere was a small amount of brown/maroon  blood in
the vault.  She was sent to GYN triage for further observation
and pain managment.  She was initially put on bed
rest in early [**Month (only) 958**] for bleeding complications.  Denies any F/C,
CP, SOB.


Past Medical History:
1. Labs: AB Pos/ Antibody Neg/RPR NR/RI/HBSAG neg
2. Dating: By LMP and First Trimester US [**2155-3-4**]
3. Prior Ultrasounds:
[**2155-4-28**]: single uterine gestation.  placenta posterior. normal
amt
amniotic fluid, no morphologic abnormalities.  moderate anterior
perigestational bleed 6.4x2.2x11.1 cm extending to the lower
uterus consistent with marginal bleed.  no retroplacental bleed.
[**2155-5-1**]: Bedside U/S: single fetus identified and fetal HR
visualized.  clot visible anteriorly
.
PMH: only seasonal allergies
PSurgicalHx: D+C for TAB
OBHx: TAB x1
.


Social History:
Non-smoker, no EtOH, no drugs or herbal supplements. She lives
with her husband. [**Name (NI) **] [**Name2 (NI) **] live in [**Country 651**].


Family History:
Non contributory

Physical Exam:
Vitals: 99.8, 80, 107/61, 18
Patient lying in bed, very uncomfortable, holding abdomen
RRR
CTAB
Abd: gravid abdomen S=D, tender over uterus superior to pubic
symphysis but otherwise non-tender without rebound/guarding.
Pelvic: Mod old blood in os.  Cx FT at ext os Long.  NT.
Extr: without edema or cords


Pertinent Results:
[**2155-5-1**] 09:36PM   TYPE-ART RATES-8/  TIDAL VOL-550 PEEP-10
PO2-80* PCO2-49* PH-7.34* TOTAL CO2-28 BASE XS-0
INTUBATED-INTUBATED
[**2155-5-1**] 09:36PM   LACTATE-3.7* K+-2.9*
[**2155-5-1**] 09:36PM   freeCa-1.17
[**2155-5-1**] 09:24PM   GLUCOSE-112* UREA N-7 CREAT-0.6 SODIUM-142
POTASSIUM-2.9* CHLORIDE-105 TOTAL CO2-23 ANION GAP-17
[**2155-5-1**] 09:24PM   estGFR-Using this
[**2155-5-1**] 09:24PM   CALCIUM-8.9 PHOSPHATE-4.4
[**2155-5-1**] 09:24PM   WBC-16.8* RBC-3.29* HGB-10.2* HCT-28.1*
MCV-85 MCH-31.0 MCHC-36.4* RDW-17.0*
[**2155-5-1**] 09:24PM   PLT COUNT-78*
[**2155-5-1**] 09:24PM   PT-14.3* PTT-39.2* INR(PT)-1.3*
[**2155-5-1**] 09:24PM   FIBRINOGE-149*
[**2155-5-1**] 09:24PM   RET AUT-1.7
[**2155-5-1**] 08:28PM   TYPE-ART PO2-95 PCO2-48* PH-7.30* TOTAL
CO2-25 BASE XS--2 INTUBATED-INTUBATED VENT-CONTROLLED

[**2155-5-1**] 07:00PM   GLUCOSE-122* LACTATE-3.7* NA+-135 K+-2.8*
CL--109
[**2155-5-1**] 07:00PM   HGB-8.9* calcHCT-27
[**2155-5-1**] 07:00PM   freeCa-0.99*
[**2155-5-1**] 07:00PM   PT-16.2* PTT-57.5* INR(PT)-1.5*
[**2155-5-1**] 07:00PM   FIBRINOGE-114*#
[**2155-5-1**] 05:59PM   TYPE-ART PO2-140* PCO2-31* PH-7.40 TOTAL
CO2-20* BASE XS--3
[**2155-5-1**] 05:59PM   GLUCOSE-108* LACTATE-4.4* NA+-133* K+-3.1*
CL--107
[**2155-5-1**] 05:59PM   HGB-9.4* calcHCT-28
[**2155-5-1**] 05:59PM   freeCa-0.62*
[**2155-5-1**] 04:08PM   PT-18.9* PTT-57.9* INR(PT)-1.8*
[**2155-5-1**] 04:08PM   FIBRINOGE-72*#
[**2155-5-1**] 03:48PM   HCT-28.3*
[**2155-5-1**] 03:48PM   PLT COUNT-148*
[**2155-5-1**] 11:20AM   WBC-18.7*# RBC-3.42* HGB-11.1* HCT-31.9*
MCV-93 MCH-32.6* MCHC-35.0 RDW-13.7
[**2155-5-1**] 11:20AM   NEUTS-93.5* BANDS-0 LYMPHS-3.2* MONOS-3.0
EOS-0.2 BASOS-0.1
[**2155-5-1**] 11:20AM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-NORMAL
[**2155-5-1**] 11:20AM   PLT SMR-NORMAL PLT COUNT-196
[**2155-5-1**] 11:20AM   PT-11.8 PTT-21.4* INR(PT)-1.0
[**2155-5-1**] 11:20AM   FIBRINOGE-576*
[**2155-5-1**] 10:48AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.026
[**2155-5-1**] 10:48AM URINE  BLOOD-LGE NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-150 BILIRUBIN-NEG UROBILNGN-NEG PH-9.0*
LEUK-MOD
[**2155-5-1**] 10:48AM URINE  RBC-35* WBC-45* BACTERIA-RARE YEAST-NONE
EPI-3

Brief Hospital Course:
32 yo G2P0 at 17 [**6-26**] wks gestational age admitted with
inevitable abortion.  Pt developed a low grade fever soon after
admission; she was presumed to have chorioamnionitis and was
started on ampicillin/gentamycin/clindamycin.  Spontaneous
vaginal delivery of the fetus occurred [**2155-5-1**].  Pt developed
postpartum hemorrhage and was taken to the OR for
ultrasound-guided dilation and curettage.  D&C was complicated
by continued hemorrhage.  Pt received uterine packing,
exploratory laparotomy, uterine massage, intrauterine injection
of uterotonics, blood transfusions, supracervical hysterectomy,
control of hemorrhage in the setting of hemorrhage, DIC and
sepsis.  Please see operative report for full details of the
procedure.
*
Following the OR, she was transferred to the ICU for further
monitoring.  She was transfered from the ICU to the floor on POD
2.
*
RESPIRATORY/HEMODYNAMICS: She was extubated on the 13th. On [**5-3**]
she desated to 93% 3L.  CXR showed atelectasis.  Transfusion
reaction studies were negative.  Desaturation resolved
spontaneously.  She remained well oxygenated and hemodynamically
stable throughout the rest of her hospitalization.

INFECTIOUS: ID was consulted and her antibiotics were switched
from amp/gent/clinda to ceftriaxone IV.  Urine and blood
cultures collected on [**5-1**] and [**5-2**] returned with E coli
pansensitive except to ampicillin.  Pathology specimens of
fetus, placenta and uterus confirmed diagnosis of
chorioamnionitis.  She spiked a fever again on the 14th to 102,
but remained afebrile throughout the rest of her
hospitalization.  Ceftriaxone was discontinued on [**5-4**] and
Unasyn started.  CT of the abdomen and pelvis [**5-4**] were negative
for abscess.  Echocardiogram [**5-7**] obtained secondary to recent
sepsis was negative for endocarditis.  Blood and urine cultures
were negative from [**5-3**] onward.  Pt was transitioned from Unasyn
to po Levofloxacin on [**5-8**].  She will continue outpt
Levofloxacin until 4/27 per ID recommendations.

HEME: Pt received 4 units pRBCs, 4 u FFP, 1 u cryo for acute
blood loss anemia and DIC in the setting of sepsis and uterine
atony.  Acute blood loss resolved after a supracervical
hysterectomy, see full operative note for full interventions.
Her Hct was low to 21.5 on POD 1 and received 1 additional u
pRBCs.  Her Hct remained stable at approximately 26 throughout
the rest of her hospitalization.  DIC resolved after treatment
of infection, above transfusions, and supportive treatment for
the pt.  Transfusion reaction labs were negative.  The pt will
resume iron treatment as an outpt once the course of
levofloxacin is complete.

GU: Pt complained of dysuria throughout the course of
hospitalization.  Repeat UA and urine cultures were negative
after [**5-2**].  It is thought that the synthetic hemostatic
material placed intraoperatively over the cervix and bladder is
causing bladder irritation.

The pt was discharged on post-op day 8 in good condition.


Medications on Admission:
Zantac
Tums
Reglan
Prenatal vitamins

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
3. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO q 6 hrs prn as
needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. Levofloxacin 250 mg Tablet Sig: Three (3) Tablet PO Q24H
(every 24 hours).
Disp:*10 Tablet(s)* Refills:*0*
5. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO q
24 hrs: start when stop antibiotic.
Disp:*90 Tablet(s)* Refills:*2*
6. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4
times a day (before meals and at bedtime)) as needed for nausea.
Disp:*20 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
spontaneous abortion with spontaneous vaginal delivery
postpartum hemorrhage
sepsis
DIC


Discharge Condition:
good


Discharge Instructions:
Please call for fevers, chills, chest pain, shortness of breath,
vaginal bleeding more than spotting, leg pain, increase in
abdominal pain, foul smelling discharge, redness or drainage
from incision, increase in pain with urination, blood in urine,
depression, any concerns.

No driving while on narcotics.

No heavy lifting for 6 weeks (nothing more than a jug of milk).

Nothing in the vagina for 6 weeks (douche, tampons,
intercourse).

No baths, swimming, hot tubs for 4 weeks.

Followup Instructions:
Please call Dr [**First Name (STitle) **] for a follow up appointment



Completed by:[**2155-5-9**]
{'Spontaneous abortion, complicated by delayed or excessive hemorrhage, incomplete,Defibrination syndrome,Acute respiratory failure,Iron deficiency anemia secondary to blood loss (chronic),Thrombocytopenia, unspecified,Septicemia due to escherichia coli [E. coli],Severe sepsis,Missed abortion,Hypotension, unspecified'}


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: Abdominal cramping

PRESENT ILLNESS: The patient is a 32 yo G2P0 woman at 17 and [**3-23**] wks who awoke
from sleep at 4am with cramping.  The cramping has been coming
more and more frequently, and now occurs at 30 second intervals.

MEDICAL HISTORY: 1. Labs: AB Pos/ Antibody Neg/RPR NR/RI/HBSAG neg
2. Dating: By LMP and First Trimester US [**2155-3-4**]
3. Prior Ultrasounds:
[**2155-4-28**]: single uterine gestation.  placenta posterior. normal
amt
amniotic fluid, no morphologic abnormalities.  moderate anterior
perigestational bleed 6.4x2.2x11.1 cm extending to the lower
uterus consistent with marginal bleed.  no retroplacental bleed.
[**2155-5-1**]: Bedside U/S: single fetus identified and fetal HR
visualized.  clot visible anteriorly
.
PMH: only seasonal allergies
PSurgicalHx: D+C for TAB
OBHx: TAB x1
.

MEDICATION ON ADMISSION: Zantac
Tums
Reglan
Prenatal vitamins

ALLERGIES: Dilaudid

PHYSICAL EXAM: Vitals: 99.8, 80, 107/61, 18
Patient lying in bed, very uncomfortable, holding abdomen
RRR
CTAB
Abd: gravid abdomen S=D, tender over uterus superior to pubic
symphysis but otherwise non-tender without rebound/guarding.
Pelvic: Mod old blood in os.  Cx FT at ext os Long.  NT.
Extr: without edema or cords

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Non-smoker, no EtOH, no drugs or herbal supplements. She lives
with her husband. [**Name (NI) **] [**Name2 (NI) **] live in [**Country 651**]. 

### Response:
{'Spontaneous abortion, complicated by delayed or excessive hemorrhage, incomplete,Defibrination syndrome,Acute respiratory failure,Iron deficiency anemia secondary to blood loss (chronic),Thrombocytopenia, unspecified,Septicemia due to escherichia coli [E. coli],Severe sepsis,Missed abortion,Hypotension, unspecified'}
